Elif Bilge UYSAL, Recep KEŞLİ, Ayşegül OPUŞ, Asuman GÜZELANT, Muhammet Güzel KURTOĞLU

Investigation of activity of tigecycline against methicillin-resistant Staphylococci strains.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant coagulase negative staphylococci (MRCNS) are important cause of infections worldwide. Vancomycin and other glycopeptide antibiotics are mainstay of therapy for infections caused by MRSA and MRCNS. High prevalence of methicillin resistant staphylococci strains led to increased use of vancomycin. This situation caused to reduction of glycopeptide susceptibility in methicillin-resistant staphylococci. Treatment options of infections due to MRSA with reduced susceptibility to vancomycin are limited. Tigecycline should be take into consideration as an antimicobial therapeutic alternative for infecitons caused by MRSA and/or MRCNS. The aim of this study was to determine in vitro antimicrobial activity of tigecycline against methicillin-resistant staphylococci strains isolated from various clinical specimens. METHODS: Staphylococcus strains isolated at the Microbiology Laboratory of Konya Education and Research Hospital in between January and December in 2010. The isolated strains were identified by using both conventional methods and fully automated bacteria identification and susceptibility system (Phoenix 100, BD, Sparks, USA). Methicillin resistance was determined and evaluated according to Clinical and Laboratory Standards Institute (CLSI) instrucions by using disc diffusion method (oxacillin 1 μg and cefoxitin 30 μg discs) Minimum inhibitory concentration (MIC) values of tigecycline for isolated strains were detected with E-test method (bio-Merieux Marcy l Etoile, France). RESULTS: Of all the eighty five methicillin-resistant staphylococci strains 35 (41%) were identified as Staphylococcus aureus and 50 (59%) coagulase negative staphylococci. MIC values of tigecycline for the 35 MRSA isolates were MIC50: 0.094 μg/ml, MIC90: 0.5 μg/ml) and for the 50 MRCNS isolates were MIC50: 0.047 μg/ml, MIC90: 0.25 μg/ml. All isolates (100%) were found to be sensitive to tigecycline. CONCLUSION: Results of this study showed that tigecycline was effective in vitro antimicrobial activity against both MRSA and MRCNS isolates. Tigecycline may be preferred as a last choice in the treatment of resistant infections due to the MRSA and MRCNS that alternative antibiotics were all resistant.

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1. Sevgican E, Sınırtaş M, Özakın C, Gedikoğlu S. Staphylococcus türlerinde metisilin direncinin farklı yöntemlerle saptanması. İnfeksiyon Dergisi, 2009; 23: 63-8.
2. Mandell GL, Bennet JE, Dolin R. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Staphylococcus aureus (Including Staphylococcal Toxic Shock). Philadelphia, Pennsylvania, Elsevier Churchill Livingstone, 2005; p. 2321-51.
3.Dowzicky MJ, Chmelařová E. Global in vitro activity of tigecycline and linezolid against Gram-positive organisms collected between 2004 and 2009. Int J Antimicrob Agents, 2011; 37(6): 562-6.
4. Petersen PJ, Jacobus NV, Weiss WJ, Sum PE, Testa RT. In vitro and in vivo antibacterial activities of novel glycylcycline, the 9-t-butylglycylamido derivate of minocycline (GAR-936). Antimicrob Agents Chemother, 1999; 43: 738-44.
5. Arslan U, Yüksekkaya Ş, Işık F, Tuncer İ. Metisiline dirençli Staphylococcus aureus suşlarının linezolid ve tigesikline in-vitro duyarlılığı. Ankem Derg, 2006; 20: 210-3.
6. Sorlozano A, Gutierrez J, Roman E, de Dios Luna J, Roman J, Liebana J, et al. A comparison of the activity of tigecycline against multiresistant clinical isolates of Staphylococcus aureus and Streptococcus agalactiae. Diagn Microbiol Infect Dis, 2007; 58: 487-9.
7. Clinical and Laboratory Standards Institute (CLSI) (Gür D: Çeviri editörü): Antimikrobik Duyarlılık Testleri İçin Uygulama Standartları, Onsekizinci Bilgi Eki, M100-S18, Türk Mikrobiyoloji Cemiyeti yayını, İstanbul, 2008.
8.9.Noskin GA. Tigecycline: A new glycylcycline for treatment of serious infections. Clin Infect Dis, 2005; 41: 303-14.
Pankey GA. Tigecycline. J Antimicrob Chemother, 2005; 56(3): 470-80.
10.Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother, 1997; 40: 135-6.
11. Tenover FC, Weigel LM, Appelbaum PC, McDougal LK, Chaitram J, McAllister S, et al. Vancomycin- resistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob Agent Chemother, 2004; 48: 275-80.
12.Zhanel GG, Karlowsky JA, Rubinstein E, Hoban D. Tigecycline: A novel glycylcycline antibiotic. Expert Rev Anti Infect Ther, 2006; 4: 9-25.
13.Betriu C, Rodriguez-Avial I, Sanchez BA, Gómez M, Alvarez J, Picazo JJ; Spanish Group of Tigecycline et al. In vitro activities of tigecycline (GAR-936) against recently isolated clinical bacteria in Spain. Antimicrob Agents Chemother, 2002; 46: 892-5.
14.Hope R, Livermore DM, Brick G, Lillie M, Reynolds R. Non-susceptibility trends among staphylococci from bacteremias in the UK and Ireland, 2001-06. J Antimicrob Chemother, 2008; 62: 65-74.
15. Hoban DJ, Bouchillon SK, Johnson BM, Johnson JL, Dowzicky MJ. Tigecycline Evaluation and Surveillance Trial (TEST Program) Group: In vitro activity of tigecycline against 6792 Gram- negative and Grampositive clinical isolates from the global tigecycline evaluation and surveillance trial (TEST Program, 2004). Diagn Microbiol Infect Dis, 2005; 52: 215-27.
16.Bouchillon SK, Hoban DJ, Johnson BM, Johnson JL, Hsiung A, dowzicky MJ. In vitro activity of tigecycline against 3989 Gram-negative and Gram-positive clinical isolates from the United States Tigecycline Evaluation and Surveillance Trial (TEST Program; 2004). Diagn Microbiol Infect Dis, 2005; 52: 173-9.
17.Tunçkanat F, Sarıbaş Z, Ercis S. Metisiline dirençli stafilokok klinik izolatlarında tigesiklin etkinliğinin araştırılması, 8. Antimikrobik Kemoterapi Günleri, Program ve Özet Kitabı s.216-7, Türk Mikrobiyoloji Cemiyeti Yayınları No:57, İstanbul, 2008.
18. Kao TM, Wang JT, Weng CM, Chen YC, Chang SC. In vitro activity of linezolid, tigecycline, and daptomycin on methicillin-resistant Staphylococcus aureus blood isolates from adult patients. 2006- 2008: Stratified analysis by vancomycin MIC. J Microbiol Immunol Infect, 2011; 20: in press.
19.Kaya O, Akçam FZ, Temel EN. In vitro activities of linezolid and tigecycline against methicillin resistant Staphylococcus aureus strains. Microb Drugs Resist, 2008; 14(2): 151-3.
20. Öksüz L, Gürler N. Klinik örneklerden izole edilen metisiline dirençli stafilokok suşlarının son yıllarda kullanıma giren antibiyotiklere in vitro duyarlılık sonuçları. Ankem Derg, 2009; 23(2): 71-7.
21. García CP, Juliet LC, Fernández VA, San Martín SM, Cifuentes DM, Porte TL, et al. Multicenter study on the monitoring of in vitro susceptibility to tigecycline in Santiago, Chile. Rev Chilena Infectol, 2009; 26: 220-6.