Edanur YEŞİL, Solmaz ÇELEBİ, Arife ÖZER, Mustafa HACIMUSTAFAOĞLU

Metisiline Dirençli Staphylococcus aureus Olgularının Değerlendirilmesi

AMAÇ: Bu çalışma, hastanemiz Çocuk Sağlığı ve Hastalıkları Kliniği’nde yatarak izlenen hastalarda metisiline dirençli Staphylococcus aureus (MRSA) enfeksiyonlu olguların incelenmesi ve ayrıca toplum kaynaklı MRSA’ya dikkat çekmek amaçlı yapılmıştır. MATERYAL ve METOD: Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniği’nde, Ekim 2012-Şubat 2017 tarihleri içerisinde yatmış olan hastalardan alınan kültürlerde S. aureus anlamlı üremesi olanlar çalışmaya dahil edildi. İstatistiksel analizlerde SPSS 17.0 programı kullanıldı. BULGULAR: Bu dönem içerisinde toplam 31 S. aureus enfeksiyonu saptandı. Staphylococcus aureus enfeksiyonu gelişen olguların 17’si (%54,8) sağlık bakımı ilişkili idi. Sağlık bakımı ilişkili stafilokok enfeksiyonlarının 12’sinde (%70,5) MRSA mevcuttu. Toplum kaynaklı 14 stafilokok enfeksiyonundan 12’sinde (%85,7) MRSA üremesi saptandı. Toplum kaynaklı MRSA enfeksiyonlu olgularının %83’ü (n=10) erkek olup ortalama yaşı 67,6±77,8 ay (medyan 26, aralık 1-204) idi. Sağlık bakımı ilişkili MRSA (SB-MRSA) enfeksiyonlu olguların %67’si (n=8) erkek olup ortalama yaşı 106,7±81,3 ay (medyan 108, aralık 0-222) idi. Toplum kaynaklı MRSA üreyen olgularda ön planda yumuşak doku enfeksiyonu tanısı mevcuttu. Sağlık bakımı ilişkili MRSA olgularında sık görülen etyolojik sebep bakteriyemi idi. Yumuşak doku enfeksiyonlarının %69'u TK-MRSA iken, diğer enfeksiyonların % 73'ü SB-MRSA'dan kaynaklanmaktadır (p=0,041). Olgularda MRSA ilişkili mortalite saptanmamıştır. SONUÇ: Çalışmamızda toplum kaynaklı stafilokok enfeksiyonlarında MRSA (%85,7) oranı yüksek bulunmuştur. Toplum kökenli MRSA, çoğu durumda yumuşak doku enfeksiyonları ve ardından septisemi ile saptanmıştır. Bakteriyemi, sağlık bakımından edinilen MRSA olgularının başlıca nedeni olmuştur.

Anahtar Kelimeler:

Çocukluk dönemi, MRSA, sağlık bakımı ilişkili enfeksiyon, Staphylococcus aureus, toplum kaynaklı enfeksiyon

Evaluation of Methicillin Resistant Staphylococcus aureus Infection in Children

BACKGROUND: This study was conducted to investigate cases of methicillin-resistant Staphylococcus aureus (MRSA) infections and also to draw attention to community-acquired MRSA in patients hospitalized at our Pediatric Clinics. METHODS: The patients who had meaningful S. aureus growth in the cultures taken from the patients who were hospitalized in Uludag University Medical Faculty Children's Health and Diseases Clinics between October 2012-February 2017 were included in the study. SPSS 17.0 program was used for statistical analysis. RESULTS: A total of 31 S. aureus infections were detected during this period. Seventeen (54.8%) of the cases with S. aureus infection were health care related. Methicillin-resistant S. aureus was present in 12 (70.5%) of the healthcare-acquired staphylococcal infections. Methicillin-resistant S. aureus was detected in 12 (85.7%) of 14 community-acquired staphylococcal infections. Eighty-three percent (n=10) of community-acquired MRSA infections were male and their mean age was 67.6 ± 77.8 months (median 26, range 1-204). Sixty-seven percent (n=8) of healthcare-acquired MRSA (HA-MRSA) were male and their mean age was 106.7±81.3 months (median 108, range 0-222). Most of the community-acquired MRSA patients were diagnosed with soft tissue infection. In the HA-MRSA cases, bacteraemia was the most common infection. Sixty-nine percent of the soft tissue infections originated from CA-MRSA, 73% of the other infections originating from HA-MRSA (p=0.041). MRSA associated mortality was not detected in the cases. CONCLUSIONS: Methicillin-resistant S. aureus (85.7%) was found to be high in community-acquired staphylococcal infections in our study. Most of the community-acquired MRSA was detected in patients with soft tissue infections, followed by septicemia. Bacteraemia was the most frequent healthcare-acquired MRSA infection.

Keywords:

Community-acquired infections, healthcare-acquired infections, methicillin-resistance, pediatrics, Staphylococcus aureus.,

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