NEVŞEHİR İLİNDEKİ HEMODİYALİZ HASTALARINDA NAZAL METİSİLİN DİRENÇLİ STAPHYLOCOCCUS AUREUS VE KOAGÜLAZ NEGATİF STAFİLOKOK TAŞIYICILIĞININ ÇEŞİTLİ YÖNTEMLERLE ARAŞTIRILMASI

Abstract

Hemodiyaliz hastalarında enfeksiyon, morbidite ve mortaliteyi etkileyen önemli faktörlerdendir. Diyalize giriş yolu, sık hospitalizasyon ve sağlık personeli ile temas enfeksiyon riskini artırmaktadır. Nazal Staphylococcus aureus ve diğer stafilokoklar, taşıyıcı hasta ve personel aracılığıyla vasküler giriş yolu enfeksiyonlarına neden olabilmektedirler. Bu çalışmada, hemodiyaliz hastalarında ve personelinde nazal S. aureus ve koagülaz negatif Staphylococcus (KNS) taşıyıcılığı tespit edilerek, izolatlarda metisilin direnci çeşitli yöntemlerle araştırılmıştır. Bu sayede, nozokomiyal enfeksiyon riskinin değerlendirilmesine katkıda bulunulması amaçlanmıştır. Çalışmaya Kasım 2019- Mart 2020 tarihleri arasında Nevşehir Devlet Hastanesi, H. Mustafa ve Türkan Öbekli Diyaliz Merkezi’nde tedavi alan 41'i kadın 52'si erkek 93 hemodiyaliz hastası ile 15 diyaliz personeli dahil edilmiştir. Aydınlatılmış onam formu imzalatıldıktan sonra nazal sürüntü örnekleri alınmıştır. Örneklerden izole edilen stafilokoklardaki metisilin direnci, Kirby-Bauer disk difüzyon yöntemi, PBP-2a lateks aglütinasyon (LA) testi ve gerçek zamanlı polimeraz zincir tepkimesi (RT-PCR) ile incelenmiştir. Hasta örneklerinin (n=93) 18’inde (%19.3) S. aureus, 11’inde (%11.8) KNS; personel örneklerinin (n=15) üçünde KNS (%20.0) ve birinde (%6.6) S. aureus izole edilmiştir. Disk difüzyon yöntemiyle hastalardan elde edilen S. aureus izolatlarından sadece birinin metisiline dirençli (%1), geri kalanının (%18.2) ve tüm KNS’lerin (%11.8) metisiline duyarlı olduğu saptanmıştır. Personel örneklerindeki KNS’lerin (%20.0) tümü metisiline duyarlı iken, izole edilen tek S. aureus dirençli bulunmuştur (%6.6). Tüm S. aureus izolatlarına (n=19), PBP-2a LA ve RT-PCR yapılmış; disk difüzyon ile metisilin dirençli S. aureus olarak tanımlanan iki izolatta da LA testi ve mecA geni pozitif bulunmuştur. Sonuç olarak, hemodiyaliz ünitelerindeki enfeksiyonların kontrolü için, portör taramalarının düzenli olarak yapılması gerekmektedir. İzole edilen mikroorganizmaların direnç profillerini saptayacak alternatif yöntemler, sağlık kuruluşunun ihtiyaçlarına ve donanımına göre tercih edilebilir.

Keywords

• hemodiyaliz
• koagülaz negatif stafilokok
• mecA
• MRSA
• nazal taşıyıcılık
• PBP-2a

Investigation of Nasal Methicillin Resistant Staphylococcus aureus and Coagulase Negative Staphylococcus Carriage by Various Methods in Hemodialysis Patients in Nevşehir Province

Abstract

Infection is one of the important factors affecting morbidity and mortality in hemodialysis patients. Access to dialysis, frequent hospitalizations, and contact with healthcare personnel increase the risk of infection. Nasal Staphylococcus aureus and other staphylococci may cause vascular access infections through carrier patients and staff. In this study, nasal S. aureus and coagulase-negative Staphylococcus (CNS) carriers were detected in hemodialysis patients and staff, and methicillin resistance in isolates was investigated by various methods. In this way, it was aimed to contribute to the assessment of nosocomial infection risk. Between November 2019 and March 2020, 93 hemodialysis patients, 41 female, 52 male, and 15 dialysis personnel treated at Nevşehir State Hospital, H. Mustafa and Türkan Öbekli Dialysis Center were included in the study. Nasal swab samples were obtained after the informed consent form was signed. Methicillin resistance in staphylococci isolated from the samples was determined by the Kirby-Bauer disk diffusion method, PBP-2a latex agglutination (LA) test, and real-time polymerase chain reaction (RT-PCR). Of the patient samples (n=93), 18 (19.3%) had S. aureus, 11 (11.8%) had CNS; of the personnel samples (n=15) CNS was isolated from three (20%) and S. aureus from one (6.6%). It was determined that one of the S. aureus isolated from the patients was methicillin-resistant (1%); the rest (18.2%) and all CNS (11.8%) were methicillin-susceptible by disk diffusion method. While all of the CNS (20%) in the personnel samples were susceptible to methicillin, only S. aureus was resistant (6.6%). The PBP-2a LA test and RT-PCR were performed on all S. aureus isolates (n=19); the PBP-2a LA test and mecA gene were positive in both isolates identified as methicillin-resistant S. aureus via disk diffusion. In conclusion, porter screenings should be done regularly to control infections in hemodialysis units. Alternative methods to determine the resistance profiles of isolated microorganisms might be preferred according to the needs and equipment of the health institution.

Keywords

• coagulase negative staphylococci
• hemodialysis
• mecA
• MRSA
• nasal carriage
• PBP-2a

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