Çocuk yoğun bakım ünitesinde yatan hastalarda vankomisine dirençli enterokok ve vankomisine dirençli genlerin tespiti

Abstract

Amaç: Vankomisine dirençli enterokok (VRE) enfeksiyonu ve kolonizasyonu, özellikle yoğun bakım ünitesi (YBÜ) hastalarında giderek artan sıklıkta görülmektedir. Bu çalışmanın amacı, Pediatrik YBÜ’de (PYBÜ) yatan hastalardan alınan sürüntü örneklerinde VRE’yi saptamak, kolonizasyonu ve izolatlar arasındaki klonal ilişkiyi araştırmaktı. Yöntem: Çalışmada, Çukurova Üniversitesi Balcalı Hastanesi PYBÜ’nde yatan 82 hastadan dış kulak yolu (DKY), göbek bölgesi ve rektal bölgeden sürüntü örnekleri alındı. Hastalardan alınan 246 sürüntü örneği Kanamisin-Esculin-Azide agara inoküle edildi. İzolatlar, BBL Crystal Gram-Positive tanımlama sistemi yardımıyla tanımlandı. İzolatların vankomisine (30 μg) duyarlılıkları Kirby-Bauer disk difüzyon yöntemi ile CLSI kriterlerine göre araştırıldı. Fenotipik olarak tanımlanmış vankomisine dirençli enterokoklarda VanA-VanB genleri, Polimeraz Zincir Reaksiyonu (PCR) yöntemi ile araştırıldı. Vankomisine duyarlı (VSE) ve dirençli enterokoklar arasındaki klonal ilişki SmaI-PFGE yöntemi ile belirlendi. Bulgular: Hastalardan alınan 246 sürüntü örneğinden 14’ü (%28.5) VRE olan toplam 49 (%20.3) enterokok suşu izole edildi. Enterokok izolatlarının 27’si (%55.10) E. faecium ve 13’ü (%26.53) E. feacalis idi. Vankomisine dirençli E. faecium ve E. feacalis izolatlarının 11’inde VanA tipi direnç tespit edilirken, hiçbir örnekte VanB tipi direnç tespit edilmedi. İzolatlar arasında önemli bir klonal ilişki yoktu. Sonuç: Çalışma boyunca PYBÜ’de VRE prevalansı yüksek olmasına rağmen enterokok enfeksiyonu gözlenmedi.

Keywords

• Vankomisine dirençli enterokoklar
• VanA
• VanB
• PCR
• SmaI-PFGE

Project Number

Cukurova University Scientific Research Projects (TF2011 LTP24)

Detection of vancomycin-resistant enterococci and vancomycin-resistance genes in patients hospitalized in the pediatric intensive care unit

Abstract

Objective: Vancomycin-resistant enterococci (VRE) infection and colonization are seen increasingly frequently, especially among intensive care unit (ICU) patients. In this study, the aim was to detect VRE in swab samples taken from patients hospitalized in the Pediatric ICU (PICU), colonization, and to investigate the clonal relationship between isolates. Method: In the present study, swab samples were taken from the external auditory canal (EAC), umbilical region, and rectal region from 82 patients hospitalized in the Çukurova University Balcalı Hospital PICU. The 246 swab samples from patients were inoculated on Kanamycin-Esculin-Azide agar. Isolates were identified with the help of the BBL Crystal Gram-Positive identification system. The susceptibility of the isolates to vancomycin (30 μg) was investigated by Kirby-Bauer disk diffusion method according to CLSI criteria. VanA-VanB genes in phenotypically defined vancomycin-resistant enterococci were investigated by Polymerase Chain Reaction (PCR) method. The clonal relationship between vancomycin-susceptible (VSE) and -resistant enterococci was determined by the SmaI-PFGE method. Results: A total of 49 (20.3%) enterococcal strains were isolated from 246 swab samples from the patients, of which 14 (28.5%) were VRE. Of the enterococci isolates, 27 (55.10%) were E. faecium and 13 (26.53%) were E. feacalis. While VanA type resistance was detected in 11 of the vancomycin-resistant E. faecium and E. feacalis isolates, VanB type resistance was not detected in any sample. There was no significant clonal relationship between the isolates. Conclusion: Although the prevalence of VRE in the PICU was high throughout the study, no enterococcal infection was observed.

Keywords

• Vancomycin-resistant enterococci
• VanA
• VanB
• PCR
• SmaI-PFGE

Supporting Institution

Cukurova University

Project Number

Cukurova University Scientific Research Projects (TF2011 LTP24)

Thanks

We would like to acknowledge Cukurova University for financially supported this project.

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