METİSİLİN DİRENÇLİ STAPHYLOCOCCUS AUREUS SUŞLARINDA IN VITRO SEFTAROLİN ETKİNLİĞİNİN ARAŞTIRILMASI

Metisilin dirençli Staphylococcus aureus (MRSA) infeksiyonları çoklu ilaç direnci nedeniyle tüm dünyada ciddi bir sorun olmaya devam etmektedir. Bu infeksiyonların tedavisinde glikopeptidler ve linezolid tercih edilen ilk ilaçlar olmalarına rağmen, son zamanlarda bu ilaçlardan özellikle vankomisine karşı minimum inhibitör konsantrasyon (MİK) değerlerinde artış saptanmış ve dirençli suşlar bildirilmeye başlanmıştır. Bu durum MRSA infeksiyonlarının tedavisinde alternatif ajanlara gereksinim duyulmasına neden olmuştur. Food and Drug Administration (FDA) tarafından cilt ve yumuşak doku infeksiyonu (CYDİ) ile toplum kökenli pnömoni (TK-Pnömoni) klinik tablolarında kullanım onayı alan seftarolin, bu kapsamda kullanılabilecek 5. kuşak sefalosporin üyesi geniş spektrumlu yeni bir antibiyotiktir. Bu çalışmada hastanemizden izole edilen MRSA suşlarında seftarolinin in vitro etkinliği araştırılmıştır.Çalışmaya Ocak 2010-Aralık 2014 tarihleri arasında, Atatürk Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi Mikrobiyoloji Laboratuvarı'na çeşitli kliniklerden gönderilen farklı klinik örneklerden (yara, kan, idrar) izole edilen 98 MRSA suşu dahil edilmiştir. Bunun için seftarolin toz etken maddesi kullanılarak sıvı mikrodilüsyon yöntemi ile seftarolin, gradiyent difüzyon yöntemi ile vankomisin ve linezolid MİK değerleri belirlenmiştir.Çalışmada seftarolin için en düşük ve en yüksek MİK değerleri 0.125-1 µg/mL iken MİK50 ve MİK90 değerleri 0.5 µg/mL ve 1 µg/mL olarak gözlenmiştir. Vankomisin için sırasıyla 0.75-1.5 µg/mL; 1 µg/mL ve 1.5 µg/mL olarak belirlenen bu değerler linezolid için yine sırasıyla 0.38-1.5 µg/mL; 0.75 µg/mL ve 1 µg/mL olarak tespit edilmiştir. Bu sonuçlara göre bütün MRSA suşları seftarolin, vankomisin ve linezolide duyarlı olarak bulunmuştur.Gösterdiği etkin in vitro aktivite nedeniyle seftarolin, MRSA infeksiyonlarının tedavisinde vankomisin ve linezolid için önemli bir alternatif olarak durmaktadır. Ancak ülkemizde halen klinik kullanımı olmayan seftarolin için ülkemizde izole edilen MRSA suşlarındaki etkinliği konusunda daha geniş kapsamlı çalışmalara gereksinim vardır

Evaluation of in Vitro Ceftaroline Activity against Methicilin Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) infections continue to be a serious problem all over the world due to multi-drug resistance. Although glycopeptides and linezolid are the first preferred drugs for treatment of these infections, resistant strains and increase of minimum inhibitory concentration (MIC) values have been detected especially against vancomycin recently. Ceftaroline is a new broad spectrum 5th generation cephalosporin approved by Food and Drug Administration (FDA) for treatment of acute bacterial skin and soft tissue infection(SSTI) and community-acquired pneumonia (CAP). In this study, in vitro activity of ceftaroline was determined in MRSA strains isolated from our hospital.Various clinical specimens (wound, blood, urine) sent from different clinical departments to Atatürk University Education and Research Hospital Medical Microbiology Laboratory between January 2010-December 2014 were included in the study. To determine ceftaroline MIC values, ceftaroline fosamil powder was used for broth microdilution method. Vancomycin and linezolid MICs were obtained by gradient diffusion method.The lowest and the highest MIC values for ceftaroline were between 0.125-1 µg/mL while the MIC50 and MIC90 values were observed as 0.5 µg/mL and 1 µg/mL. The lowest and the highest MIC values for vancomycin were 0.75-1.5 µg/mL and the MIC50MIC90 values were 1 µg/mL - 1.5 µg/mL. These values were determined as 0.38-1.5 µg/mL and 0.75 µg/mL-1 µg/mL for linezolid respectively. According to these results, all MRSA strains were susceptible to ceftaroline, vancomycin and linezolid.Because of its excellent in vitro activity, ceftaroline stands as an important alternative for vancomycin and linezolid in the treatment of infections caused by MRSA. However, as there is no clinical use for ceftaroline in our country yet, more extensive studies are needed to understand the effectiveness of ceftaroline against MRSA strains isolated in our country

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