Türkiye'nin güneyinde üçüncü basamak bir hastanede çocuklarda Staphylococcus aureus enfeksiyonlarının klinik özellikleri ve direnç paternleri

Year 2022, Volume: 47 Issue: 2, 580 - 588, 30.06.2022

Ümmühan Çay , Umit Celik , Adnan Barutçu , Ulaş Özdemir , Nevzat Ünal

Abstract

Amaç: Bu çalışmda çocuklarda invaziv enfeksiyonların önde gelen bir nedeni olan Staphylococcus aureus (S. aureus) izolatlarının klinik ve demografik özelliklerinin, antistafilokokal antibiyotiklere direnç durumlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Temmuz 2018-Temmuz 2020 tarihleri arasında Çocuk Sağlığı ve Hastalıkları Kliniği'nde takip edilen, apse, yara, kan, beyin omurilik sıvısı, eklem sıvısı ve diğer steril vücut sıvısı kültürlerinde S. aureus üremesi olan 18 yaş altı hastaların dosya kayıtları retrospektif olarak incelendi.
Bulgular: 135 hasta çalışmaya alındı. Hastaların 105’inde (77.7%) toplum kökenli, 30’unda (22.3%) ise hastane kökenli S. aureus (HA-SA, Hospital Acquired S. aureus) enfeksiyonu mevcuttu. S. aureus en yaygın olarak cilt ve yumuşak doku enfeksiyonlarında saptandı. Toplum kökenlilerde cilt ve yumuşak doku enfeksiyonları, nozokomiyallerde ise bakteriyemi sık gözlendi. Tüm hastaların %53.3’ünde metisilin dirençli S. aureus (MRSA); %20’sinde klindamisin, %14.4’ünde mupirosin direnci saptandı. Toplum Kökenli S. aureus’ların (CS-SA, Community-acquired SA) %55,8’i, HA-SA’ların %46,7’si MRSA idi. MRSA olanlarda penisilin, mupirosin, eritromisin ve tetrasiklin direnci anlamlı derecede daha fazlaydı. CA-SA’larda mupirosin direnci anlamlı derecede daha fazlaydı. Yatış süresi median 12 gündü. Yatış süresi, IV antibiyotik alma süresi, mortalite, klindamisin direnci HA-MRSA enfeksiyonlarında anlamlı derecede daha yüksekti. S. aureus enfeksiyonlarında mortalite %2.2 iken, HA-SA enfeksiyonlarında mortalite %10 olarak saptandı.
Sonuç: Toplum kökenli MRSA oranlarımız oldukça yüksek olup; klindamisin ve mupirosin direnci bölgemizde önemli bir sorun olarak görünmektedir. Doğru zamanda, uygun kültür örneğinin alınması; direnç paternlerinin ve ampirik tedavi rejimlerinin belirlenmesinde önemlidir.

Keywords

Staphylococcus aureus, Çocuk, Klinik Özellikler, Antibiyotik direnci

Clinical characteristics and resistance patterns of Staphylococcus aureus infections in children at a tertiary care hospital in southern Turkey

Abstract

Purpose: The aim of this study was to evaluate the clinical and demographic characteristics and resistance patterns to antistaphylococcal antibiotics of Staphylococcus aureus (S. aureus) isolates, which is a leading cause of invasive infections in children.
Materials and Methods: Patients who were under 18 years of age and who had S. aureus growth in abscess, wound, blood, cerebrospinal fluid, joint fluid and any other sterile body fluid cultures, who were followed up at Children’s Health and Diseases Clinic in between July 2018 and July 2020 were included in the study.
Results: A total of 135 patients and cultures were included in the study. Community-acquired S. aureus (CA-SA) infection was present in 105 (77.7%) patients and hospital-acquired S. aureus (HA-SA) infections in 30 (22.3%). S. aureus was most commonly detected in skin and soft tissue infections. Skin and soft tissue infections were more common in patients with community-acquired disease, whereas bacteremia was more common in patients with nosocomial infection. Methicillin-resistant S. aureus (MRSA) isolates was encountered in 53.3% of all patients; Clindamycin resistance was found in 20% of all staphylococcal isolates and the ratio of mupirocin resistance was 14.4%.55.8% of all CA-SA and 46.7% of all HA-SA isolates were MRSA. Penicillin, mupirocin, erythromycin, and tetracycline resistance were significantly higher in MRSA isolates as compares to non-MRSA isolates. Mupirocin resistance was significantly higher in CA-SA isolates. The median length of hospital stay was 12 days. Length of hospital stay, duration of intravenous antibiotics use, mortality, and clindamycin resistance were significantly higher in patients with HA-MRSA infections. While overall mortality was 2.2% in patients with S. aureus infections, when evaluated separately, it was 10% in patients with HA-SA infections.
Conclusion: Our CA-MRSA rates are quite high as compared to other reports, and clindamycin and mupirocin resistance seems to be an important problem in our region. Taking appropriate cultures at the right time is important in determining resistance patterns and guiding empirical treatment regimens.

Keywords

Staphylococcus aureus, Child, Clinical Characteristics, Antibiotic resistance

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