Çeşitli klinik örneklerden izole edilen MRSA suşlarının antibiyotiplendirilmesi ve eritromisin zon içi üreme gösteren MRSA suşları

Hastanemizde kaç tip MRSA bulunduğunu saptamak için, Nisan 2005 ile Haziran 2006 arasında, Türkiye Yüksek İhtisas Hastanesi Mikrobiyoloji Laboratuvarında izole edilen 233 MRSA suşunun 17 farklı antibiyotiğe duyarlılık paternleri disk difüzyon yöntemi ile belirlenmiştir. Antibiyotiplendirme amacıyla kullanılan antibiyotikler oksasilin, sefoksitin, amoksisilin-klavulanat, eritromisin, gentamisin, amikasin, tobramisin, levofloksasin, rifampisin, tetrasiklin, linezolid, vankomisin, teikoplanin, netilmisin, fusidik asit, kloramfenikol ve trimetoprim-sulfametoksazol olmuştur. Değerlendirmeler bütün antibiyotikler için duyarlı, dirençli ve eritromisin için ayrıca heterorezistan (zon içi üreme gösteren) olarak yapılmış, buna göre eritromisine dirençli (ER) ve eritromisine heterorezistan (EHR) olmak üzere 2 farklı MRSA suşunun hastanemizde endemik olarak bulunduğu saptanmıştır. Ayrıca, bu suşlardan ve birbirlerinden farklı olan 2 MRSA suşu daha saptanmıştır ve bu suşlar sadece izole edildiği hastalarda sınırlı kalmıştır. Eritromisin zon içi üreme gösteren MRSA suşlarından bazıları daha detaylı incelenmiş ve sonuçları ayrıca değerlendirilmiştir. Hastanelerin mikrobiyoloji laboratuvarlarında izole edilen MRSA suşlarının takip edilmesi, en azından antibiyotiplendirilmesinin yapılması, suşun endemik olup olmadığını belirlemede yol gösterici olurken hastaneye yeni bir suş girdiğinde de farkına varılmasını sağlayacak ve gerekli önlemlerin alınması için uyarıcı olacaktır.

Anahtar Kelimeler:

Anti-bakteriyel ajanlar, İlaç direnci, Eritromisin, Mikrobiyal duyarlılık testleri

Antibiotyping of MRSA strains isolated from various clinical samples and MRSA strains exhibiting microcolonies within the inhibition zone of erythromycin

To investigate how many types of MRSA strains exist in our hospital, a total of 233 MRSA isolates collected at Turkiye Yuksek Ihtisas Hospital from April 2005 to June 2006 were characterized by antibiotyping, as determined by the disk diffusion method. The antimicrobial agents evaluated were as follows: oxacillin, cefoxitin, amoxicillin-clavulanate, erythromycin, gentamicin, amikacin, tobramycin, levofloxacin, rifampicin, tetracycline, linezolid, vancomycin, teicoplanin, netilmicin, fusidic acid, chloramphenicol and trimethoprim-sulfamethoxazole. Our results revealed that two different antibiotypes of MRSA strains based on the difference only in erythromycin sensitivity as of erythromycin resistant (ER) and erythromycin heteroresistant (EHR, with some colonies within the inhibition zone) were endemic in our hospital. In addition to these types, two antibiotypes of MRSA different from each other and from ER and EHR phenotypes were also isolated from two patients. These two remained restricted only to the patients from whom the strains were isolated. Some of the EHR strains were studied more detailed and the results obtained were also evaluated. It would be highly beneficial to follow up the MRSA isolates and at least antibiotyping of them would provide the knowledge about the existing endemic strains and awareness of a different strain entrance and consequently, preventive measures could be taken.

Keywords:

Anti-Bacterial Agents, Drug Resistance, Erythromycin, Microbial Sensitivity Tests,

PDF

___

Amorim ML, Aires de Sousa M, Sanches IS et al: Clonal and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus (MRSA) from a Portuguese hospital over time, Microb Drug Resist 2002;8(4):301-9.
Archer GL, Mayhall CG: Comparison of epidemiological markers used in the investigation of an outbreak of methicillin-resistant Staphylococcus aureus, J Clin Microbiol 1983;18(2):395-9.
Arpin C, Lagrance I, Gachie JP, Bebear C, Quentin C: Epidemiological study of an outbreak of infection with Staphylococcus aureus resistant to lincosamides and streptogramin A in a French hospital, J Med Microbiol 1996;44(4):303-10.
Aubry-Damon H, Legrand P, Brun-Buisson C, Astier A, Soussy C J, Leclercq R: Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus: roles of an infection control program and changes in aminoglycoside use, Clin Infect Dis 1997;25(3):647-53.
Aucken HM, Gamier M, Murchan S, Cookson BD, Johnson AP: A new UK strain of epidemic methicillin-resistant Staphylococcus aureus (EMRSA-17) resistant to multiple antibiotics, J Antimicrob Chemother 2002;50(2):171-5.
Beretta AL, Trabasso P, Stucchi RB, Moretti ML: Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a university hospital from 1991 to 2001, Braz J Med Biol Res 2004;37(9):1345-51.
Blanc DS, Lugeon C, Wenger A, Siegrist HH, Francioli P: Quantitative antibiogram typing using inhibition zone diameters compared with ribotyping for epidemiological typing of methicillin-resistant Staphylococcus aureus, J Clin Microbiol 1994;32(10):2505-9.
Chen ML, Chang SC, Pan HJ et al: Longitudinal analysis of methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan, J Formos Med As soc 1999;98(6):426-32.
Denis O, Deplano A, Nonhoff C, Ryck RD et al: National surveillance of methicillin-resistant Staphylococcus aureus in Belgian hospitals indicates rapid diversification of epidemic clones, Antimicrob Agents Chemother 2004;48(9):3625-9.
Donnio PY, Louvet L, Preney L, Nicolas D, Avril JL, Desborders L: Nine-year surveillance of methicillin-resistant Staphylococcus aureus in a hospital suggests instability of mecA DNA region in an epidemic strain, J Clin Microbiol 2002;40(3):1048-52.
Galdbart JO, Morvan A, El Solh N: Phenotypic and molecular typing of nosocomial methicillin-resistant Staphylococcus aureus strains susceptible to gentamicin isolated in France from 1995 to 1997, J Clin Microbiol 2000;38(1):185-90.
Hoefnagels-Schuermans A, Peetermans WE, Struelens MJ, Van Lierde S, Van Eldere J: Clonal analysis and identification of epidemic strains of nosocomial methicillin-resistant Staphylococcus aureus by antibiotyping and determination of protein A gene and coagulase gene polymorphisms, J Clin Microbiol 1997;35(10):2514-20.
Hsu RB, Chen ML, Chang SC et al: Perfusionist-transmitted bacterial mediastinitis in a heart transplant recipient, Tex Heart Inst J 2001;28(1):60-2.
Montestinos I, Salido E, Delgado T, Cuervo M, Sierra A:Epidemiologic genotyping of methicillin-resistant Staphylococcus aureus by pulse-field gel electrophoresis at a university hospital and comparison with antibiotyping and protein A and coagulase gene polymorphisms, J Clin Microbiol 2002;40(6):2119-25.
National Committee for Clinical Laboratory Standards: Performance Standards for Antimicrobial Susceptibility Testing; Tenth Informational Supplement M100-S1O, NCCLS, Wayne, PA (2000).
Nimmo GR, Schooneveldt J, O'Kane G, McCall B, Vickery A: Community acquisition of gentamicin-sensitive methicillin-resistant Staphylococcus aureus in Southeast Queensland, Australia, J Clin Microbiol 2000;38(11):3926-31.
O'Brien FG , Pearman JW, Gracey M, Riley TV, Grubb WB: Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak, J Clin Microbiol 1999;37(9):2858-62.
Şimşek Yavuz S, Kocagöz S, Göktaş P, Ünal S: Hastane infeksiyonu etkeni olan metisilin dirençli Staphylococcus aureus suşlarmın "Arbitrarily rimed-Polymerase Chain Reaction (AP-PCR)" yöntemi ile epidemiyolojik incelenmesi, Flora 2001;6(4):231-9.
Tenover FC, Arbeit R Archer G et al: Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus, J Clin Microbiol 1994;32(2):407- 15.
Wilailuckana C, Tribuddharat C, Tiensasitorn C et al: Dicriminatory powers of molecular typing techniques for methicillin-resistant Staphylococcus aureus in a university hospital, Thailand, South East Asian J Trop Med Public Health 2006;37(2):327-34.
Zelanzy AM, Ferraro MJ, Glennen A et al: Selection of strains for quality assesment of the disk induction method for detection of inducible clindamycin resistance in staphylococci: a CLSI collaborative study, J Clin Microbiol 2005;43(6):2613-5.