Mehmet Çabalak, Ahmet Kalkan, Nuran Akmirza İnci, Ahmet Çalışkan, Kutbeddin Demirdağ

Clonal relation of nasal MRSA carrier status among hospital personnel, hospitalized patients and community

Amaç: Sağlık çalışanları, hospitalize hastalar ve sağlıklı gönüllülerde nazal metisilin-dirençli Staphylococcus aureus (MRSA) kolonizasyonu ve klonal dağılımı pulsed field gel electrophoresis (PFGE) ile araştırıldı.Yöntemler: Çalışmaya 403 hastane çalışanı, 744 hasta ve 204 sağlıklı toplum bireyi alındı. Mikrobiyolojik işlemler Fırat Üniversitesi Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı Bakteriyoloji Laboratuarı’nda, PFGE işlemi ise İnönü Üniversitesi Mikrobiyoloji Anabilim Dalı’nda çalışıldı.Bulgular: Toplam 1351 nazal sürüntü kültüründen 296 Staphylococcus aureus suşu izole edildi ve bunların 69 (% 23,3)’u MRSA idi. Nazal S. aureus taşıyıcılığı sağlık çalışanları ve hastalar arasında benzer idi (p=0,14). Sağlıklı gönüllü gurupta ise diğer guruplara göre anlamlı derecede az olarak bulundu (p=0,02). PFGE yöntemiyle 66 MRSA suşunun 17 (% 25,8)’sinin küme içinde olduğu saptandı. Bu suşlar 7 küme içinde yer almaktaydı. Tiplendirilen suşların 21 tanesi yakın ilişkili, ikisi ise muhtemel ilişkili olarak saptandı. Yirmi altı suş klonal olarak ilişkisiz bulundu. Toplam 66 suş içinde 33 (% 50) PFGE paterni belirlendi.Sonuç: Çalışmamız sonucunda MRSA suşlarının aynı hastane içinde daha fazla olmakla birlikte bölgedeki hastaneler arasında ve hastane-toplum arasında taşınabileceğini gördük. Çalışmadan elde edilen sonuçlar toplumda artan MRSA enfeksiyon sıklığı için bir indikatör olabilir. MRSA’nın klonal dağılımının saptanması ve epidemiyolojisinin belirlenmesi için çok merkezli çalışmalara ihtiyaç olduğunu ve MRSA epidemiyolojisinin aydınlatılmasının MRSA’ya bağlı enfeksiyonların önlenmesi ve kontrolünde yardımcı olacağını düşünüyoruz

Anahtar Kelimeler:

MRSA, nazal taşıyıcılık, PFGE

Clonal relation of nasal MRSA carrier status among hospital personnel, hospitalized patients and community

Objective: Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) among the healthcare workers (HCWs), hospitalized patients, and healthy individuals was investigated by pulsed field gel electrophoresis (PFGE) for defining of clonally distribution of them. Methods: Totally 403 healthcare personnel, 744 patients, and 204 healthy individuals from the population were enrolled. Microbiological procedures were performed in the Bacteriological Laboratory at the Clinical Microbiology and Infectious Diseases Department of Firat University, and PFGE procedures were performed in the Microbiology Department of Inonu University. Results: Staphylococcus aureus was isolated in 296 (21.9%) of 1351 nasal swabs, and 69 out of 296 (23.3%) were defined as MRSA. Nasal S.aureus carrier state was identical between the patients and HCWs carrier state (p=0.14). It was significantly lower in healthy subjects than the other groups (p=0.02). Seventeen (25.8%) of 66 MRSA strains were defined to be in the cluster. These strains were in 7 different clusters. Among the typed strains, 21 had close relationship, 2 had possible relationship, and 26 had no relation. PFGE pattern was defined in 33 (50%) out of 66 strains and it was inconclusive in 3 strains. Conclusion: MRSA strains can be transferred commonly in the same hospital, among the hospitals located in the same region and the population. The results might be the indicators of increasing frequencies in population based MRSA infections. Multi-center studies are required to define clonally distribution of MRSA and the explanation of epidemiology may be helpful for preventing and controlling of MRSA related infections.

Keywords:

MRSA, nasal carrier, PFGE,

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