Beyin cerrahisi ameliyatı sonrasında metisiline dirençli staphylococus aureus’a bağlı spondilodiskit gelişen olgu

Yıl 2021, Cilt: 2 Sayı: 1, 28 - 32, 15.06.2021

Merve Sarı , Selin Şenol , Salih Cesur , Gunay Tuncer Ertem , Metin Özsoy , Cigdem Ataman Hatipoglu , Sami Kınıklı

Öz

Metisiline dirençli Staphylococcusaureus (MRSA) sıklıkla hastane kaynaklı nadiren ise toplum kaynaklı infeksiyonlara neden olabilir. MRSA’ya bağlı spondilodiskit oldukça nadir görünen bir klinik tablodur. Bu yazıda, MRSA’ya bağlı cerrahi girişim sonrasında spondilodiskit gelişen, infeksiyon odağı araştırılmasına rağmen saptanamayan, 49 yaşında kadın hasta sunularak tedavi gözden geçirildi. Hastada 4 hafta intravenöz teikoplanin tedavisi sonrasında görüntüleme, klinik, ve laboratuvar bulguları geriledi, tedavisi 6 haftaya tamamlanmak üzere oral tedavi ile hasta taburcu edildi.
Sonuç olarak, ameliyat sonrasında spondilodiskit gelişen hastalarda etkeninin hastane kaynaklı MRSA olabileceği akılda tutulmalı ve hastalardan tanıya yönelik gerekli mikrobiyolojik incelemeler yapılmalıdır.

Anahtar Kelimeler

spondilodiskit, metisiline dirençli Staphylococcus aureus, tedavi

Spondylodiscitis case due to methicilline-resistant staphylococus aureus after neurosurgery

Öz

Methicillin-resistant Staphylococcusvaureus (MRSA) can cause hospital-acquired infections and rarely community-acquired infections. Spondylodiscitis due to MRSA is an extremely rare clinical picture. In this article, a 49-year-old female patient who developed spondylodiscitis after surgical intervention due to MRSA and whose infection focus was not detected despite of investigating, was presented and the treatment was reviewed. After 4 weeks of intravenous teicoplanin treatment, imaging, clinical, and laboratory findings were regressed, and the patient was discharged with oral treatment to complete 6 weeks.
In conclusion, it should be kept in mind that in patients with spondylodiscitis after surgical operation, the causative agent may be nosocomial MRSA and diagnostic microbiological investigations should be performed.

Anahtar Kelimeler

spondylodiscitis, Methicillin resistant Staphylococcus aureus, treatment

Kaynakça

• 1. Sasajı T, Yamada N, Iwaı K. Microorganisms causing pyogenic spondylitis: Comparison of community and hospital-acquired types. Upsala Journal of Medical Sciences 2012; 117: 399–401.
• 2. Masuda T, Miyamoto K, Hosoe H, Sakaeda H, Tanaka M, Shimizu K. Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases. Arch Orthop Trauma Surg 2006 ; 126: 339-45.
• 3. Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012; 36: 413-420.
• 4. Özgüler M, Özden M. Tüberküloza Bağlı Spondilodiskit Olgularının İrdelenmesi.Van Tıp Derg 2016; 23: 154-158.
• 5. Berbari EF, Steckelberg JM, Osmon DR. Osteomyelitis. In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett's Principles and Practice of InfectiousDiseases. 7th ed. Philadelphia: Churchill Livingstone, 2010: 1457-67.
• 6. Govender S. Spinal infections. J Bone Joint Surg Br 2005; 87: 1454-8.
• 7. Hatipoğlu ÇA, Arslan K, Bulut C, Tufan ZK, Gül YK, Kınıklı S, Demiröz AP. Spondilodiskitli hastaların epidemiyolojik, klinik ve laboratuvar özelliklerinin değerlendirilmesi. Flora 2013; 1: 28- 33.
• 8. Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan HA. Comparativeanalysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007; 55: 158-63.
• 9. Mete B, Kurt C, Yilmaz MH et al. Vertebralosteomyelitis: eightyears' experience of 100 cases. Rheumatol Int 2012; 32: 3591-7.
• 10. Hamidi AA, Özsüt H , Başaran S, Çağatay A, Eraksoy H.Tüberkülöz, Pyojenik ve Brucella’ya Bağlı Spondilodiskit: 103 Olgunun Klinik ve Laboratuvar Özellikleri. Klimik Dergisi 2015; 28: 80-6.
• 11. Dhanoa A,  Singh VA, Mansor A, Yusof MY, Lim KT,  Thong KL. Acute haematogenous community-acquired methicillin-resistant Staphylococcus aureus osteomyelitis in an adult: case report and review of literature. BMC InfectiousDiseases 2012; 12:270.
• 12. Al-Nammari SS, Lucas JD, Lam KS. Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis. Spine 2007 ; 32: 2480-6.
• 13.Finsterer J, Mahr K, Paral V. Favorableoutcome of long-lasting thoracic spondylodiscitis with spinal epidural abscess induced byStaphylococcus aureus. South Med J 2003;96:70-3.
• 14. Hatzenbuehler J , Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician 2011; 84: 1027-33.
• 15. David MZ  and  Daum RS. Community-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic. Clin Microbiol Rev 2010; 23: 616–687.
• 16. Cadena J,  Thinwa J,  Walter EA,  Frei CR Risk factors for the development of active methicillin-resistant Staphylococcus aureus (MRSA) infection in patients colonized with MRSA at hospital admission. Am J Infect Control 2016; 44: 1617-1621.
• 17. Hitchon PW, Osenbach RK, Yuh WT, Menezes AH. Spinal infections. Clin Neurosurg 1992; 38:373-87.
• 18. Rath SA, Neff U, Schneider O, Richter HP. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 1996;38:926-33.
• 19. Nusair  AR,  Nekidy WSE, Reynolds L,  Evans D, El-Lababidi R, Alatoom A. Comprehensive Approach to Reduce Surgical Site Infections in Patients Undergoing Neurosurgical Procedures. Surg Infect (Larchmt) 2021 ;22: 217-221.
• 20. Agarwal L, Singh AK, Sengupta C, and  Agarwal A. Nasal carriage of Methicillin- and Mupirocin-resistant S. aureus among health care workers in a tertiary care hospital. J Res Pharm Pract. 2015 ; 4: 182–186.
• 21. George S, Leasure AR, Horstmanshof D. Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections: A Systematic Review. Dimens Crit Care Nurs. 2016; 35: 204-22.