Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research

Year 2019, Volume: 46 Issue: 1, 51 - 64, 03.03.2019

Narin Gündoğuş Kadri Gül Tuba Dal Nezahat Akpolat

https://doi.org/10.5798/dicletip.534830

Abstract

Objective:
Nasocomial infections are major health problems due to their high morbidity and
mortality, prolonged hospital duration and higher treatment costs.
Methicillin-resistant staphylococcus
species became one of the leading bacteria causing nasocomial infections
especially in intensive care units, recently.

The minimum
inhibitory concentration value of an antibiotic gives the concentration of
antibiotic needed to inhibit the bacteria in the infection area. Careful
monitoring of minimal inhibitory concentration (MIC) values is necessary
especially during long-term treatments of meticillin-resistant Staphylococcus aureus (MRSA) and
meticillin-resistant coagulase-negative staphylococci (MRCoNS) infections^1,2.
Increasing antibiotic resistance in methicillin-resistant staphylococci, has
led to the need for different antibiotics.

Methods: A
total of 60 meticillin-resistant staphylococci strains isolated in Microbiology
Laboratory of Dicle University Hospital, from clinical specimens of patients in
adult İntensive Care Units (ICUs) between April 2013 and March 2014 were included
in this study. After identification with conventional and automated system, the
antibiotic susceptibility rates of vancomycin, teicoplanin, daptomycin,
linezolid, quinupristin/dalfopristin, tigecycline, ceftaroline were determined
by E-test method.

Results:
The majority of the samples (26.7%) were sent from Pulmonary Diseases and
Tuberculosis intensive care unit and the blood samples were the most common
materials (80%) . All staphylococcal strains in our study were determined as
susceptible to vancomycin, daptomycin, linezolid, teicoplanin and tigecycline.
One (1.6%) MRCoNS isolate was resistant to quinupristin/dalfopristin while 11
(36.6%) of the MRSA isolates were resistant to ceftaroline. In comparison with
the MIC values of MRSA and MRCoNS, only tigecycline was significantly
different. Thirty MRSA strains were evaluated in terms of
vancomycin-intermediate Staphylococcus
aureus/heteroresistant vancomycin-intermediate Staphylococcus aureus (VISA/hVISA) with macro E-test method; any
VISA/hVISA isolate was not detected.

Antibiotic
concentrations below the MIC level, not only leads to treatment failure but
also causes mutant bacteria to appear. In order to control the resistance to
antibiotics in the treatment of infections due to MRSA and MRCoNS agents, the
clinician should be notified of the MIC values of the drugs and the treatment
should be planned accordingly.

VISA/hVISA isolates
should be considered in treatment failures of infections due to MRSA which are
in vitro susceptible to vancomycin. Further testing is needed to detect these
isolates.

Despite the
fact that ceftaroline is not a drug used in our country, the high resistance
rate in our study is remarkable. This situation may be due to the intensive use
of other beta-lactam antibiotics. Therefore, antibiotic susceptibility results
should be taken into consideration during planning the treatment of infections.

The high
average MIC values of tigecycline in MRCoNS infections should also be monitored
carefully

Keywords

Methicillin-resistant staphylococci, MIC, E-test

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