Metisiline Dirençli Staphylococcus aureus Olgularının Değerlendirilmesi

Yıl 2019, Cilt: 17 Sayı: 1, 121 - 127, 01.04.2019

Edanur Yeşil , Solmaz Çelebi Arife Özer Mustafa Hacımustafaoğlu

Öz

AMAÇ:
Bu çalışma, hastanemiz Çocuk Sağlığı ve Hastalıkları Kliniği’nde yatarak
izlenen hastalarda metisiline dirençli Staphylococcus
aureus (MRSA) enfeksiyonlu
olguların incelenmesi ve ayrıca toplum kaynaklı MRSA’ya dikkat çekmek amaçlı
yapılmıştır.

MATERYAL
ve METOD: Uludağ Üniversitesi Tıp Fakültesi Çocuk
Sağlığı ve Hastalıkları Kliniği’nde, Ekim 2012-Şubat 2017 tarihleri içerisinde
yatmış olan hastalardan alınan kültürlerde S.
aureus anlamlı üremesi olanlar
çalışmaya dahil edildi. İstatistiksel analizlerde SPSS 17.0 programı
kullanıldı.

BULGULAR:
Bu dönem içerisinde toplam 31 S. aureus
enfeksiyonu saptandı. Staphylococcus
aureus enfeksiyonu gelişen olguların 17’si (%54,8) sağlık bakımı ilişkili
idi. Sağlık bakımı ilişkili stafilokok enfeksiyonlarının 12’sinde (%70,5) MRSA
mevcuttu. Toplum kaynaklı 14 stafilokok enfeksiyonundan 12’sinde (%85,7) MRSA
üremesi saptandı. Toplum kaynaklı MRSA enfeksiyonlu olgularının %83’ü (n=10)
erkek olup ortalama yaşı 67,6±77,8 ay (medyan 26, aralık 1-204) idi. Sağlık
bakımı ilişkili MRSA (SB-MRSA) enfeksiyonlu olguların %67’si (n=8) erkek olup
ortalama yaşı 106,7±81,3
ay (medyan 108, aralık 0-222) idi. Toplum kaynaklı
MRSA üreyen olgularda ön planda yumuşak doku enfeksiyonu tanısı mevcuttu. Sağlık
bakımı ilişkili MRSA olgularında sık görülen etyolojik sebep bakteriyemi idi.
Yumuşak doku enfeksiyonlarının %69'u TK-MRSA iken, diğer enfeksiyonların % 73'ü
SB-MRSA'dan kaynaklanmaktadır (p=0,041). Olgularda MRSA ilişkili mortalite
saptanmamıştır.

SONUÇ: Çalışmamızda toplum kaynaklı stafilokok enfeksiyonlarında MRSA
(%85,7) oranı yüksek bulunmuştur. Toplum kökenli MRSA, çoğu durumda yumuşak
doku enfeksiyonları ve ardından septisemi ile saptanmıştır. Bakteriyemi, sağlık
bakımından edinilen MRSA olgularının başlıca nedeni olmuştur.

Anahtar Kelimeler

Çocukluk dönemi, MRSA, sağlık bakımı ilişkili enfeksiyon, Staphylococcus aureus, toplum kaynaklı enfeksiyon

Evaluation of Methicillin Resistant Staphylococcus aureus Infection in Children

Öz

BACKGROUND: This study was conducted to investigate cases of
methicillin-resistant Staphylococcus
aureus (MRSA) infections and also to draw attention to community-acquired
MRSA in patients hospitalized at our Pediatric Clinics. 

METHODS: The patients who had meaningful S. aureus
growth in
the cultures taken from the patients who were hospitalized in Uludag University
Medical Faculty Children's Health and Diseases Clinics between October
2012-February 2017 were included in the study. SPSS 17.0 program was used for
statistical analysis.

RESULTS: A total of 31 S.
aureus infections were detected during this period. Seventeen (54.8%) of
the cases with S. aureus infection
were health care related. Methicillin-resistant S. aureus was present in 12 (70.5%) of the healthcare-acquired
staphylococcal infections. Methicillin-resistant S. aureus was detected in 12 (85.7%) of 14 community-acquired staphylococcal
infections. Eighty-three percent (n=10) of community-acquired MRSA infections
were male and their mean age was 67.6 ± 77.8 months (median 26, range 1-204). Sixty-seven
percent (n=8) of healthcare-acquired MRSA (HA-MRSA) were male and their mean
age was 106.7±81.3 months (median 108, range 0-222). Most of
the community-acquired MRSA patients were diagnosed with soft tissue infection.
In the HA-MRSA cases, bacteraemia was the most common infection. Sixty-nine
percent of the soft tissue infections originated from CA-MRSA, 73% of the other
infections originating from HA-MRSA (p=0.041). MRSA associated mortality was not detected
in the cases.

CONCLUSIONS: Methicillin-resistant S. aureus (85.7%) was found to be high in community-acquired
staphylococcal infections in our study. Most of the community-acquired MRSA was
detected in patients with soft tissue infections, followed by septicemia. Bacteraemia
was the most frequent healthcare-acquired MRSA infection. 

Anahtar Kelimeler

Community-acquired infections, healthcare-acquired infections, methicillin-resistance, pediatrics, Staphylococcus aureus.

Kaynakça

• 1. Jevons MP, Coe AW, Parker MT. Methicillin resistance in staphylococci. Lancet. 1963;1(7287):904-7.
• 2. Patel M. Community-associated meticillin-resistant Staphylococcus aureus infections. Drugs. 2009(69.6 ):693-716.
• 3. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298(15):1763-71.
• 4. Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J M. 2005;352(14):1436-44.
• 5. Wayne PA. Performance standards for antimicrobial susceptibility testing. Clinical and laboratory standards institute. 2012(22nd Informational Supplement):M100- S22.
• 6. de Kraker ME, Davey PG, Grundmann H, group Bs. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011;8(10):e1001104.
• 7. Agca H, Topac T, Ozmerdiven GE, Celebi S, Koksal N, Hacimustafaoglu M, et al. Investigation of methicillin resistant Staphylococcus aureus in neonatal intensive care unit. Int J Clin Exp Med. 2014;7(8):2209-13.
• 8. Etienne J. Panton-Valentine leukocidin: a marker of severity for Staphylococcus aureus infection? Clin Infect Dis. 2005;41(5):591-3.
• 9. Benoit SR, Estivariz C, Mogdasy C, Pedreira W, Galiana A, Galiana A, et al. Community strains of methicillin-resistant Staphylococcus aureus as potential cause of healthcare-associated infections, Uruguay, 2002-2004. Emerg Infect Dis. 2008;14(8):1216-23.
• 10. Sutton JP, Steiner CA. Hospital-, Health Care-, and Community-Acquired MRSA: Estimates From California Hospitals, 2013: Statistical Brief #212. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD)2006.
• 11. Celebi S, Hacimustafaoglu M, Ozdemir O, Ozakin C. Nosocomial Gram-positive bacterial infections in children: results of a 7 year study. Pediatrics Int. 2007;49(6):875-82.
• 12. Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):19688.
• 13. Baran CB. Investigation of Panton-Valentine leukocidin gene, SCCmec gene cassette types and genotypes of methicillin-resistant Staphylococcus aureus strains isolated from outpatients. Mikrobiyol Bul. 2010;44.4:533-45.
• 14. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. New Engl J M. 2006;355(7):666-74.
• 15. King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144(5):309-17.
• 16. Kaku N, Yanagihara K, Morinaga Y, Yamada K, Harada Y, Migiyama Y, et al. Influence of antimicrobial regimen on decreased in-hospital mortality of patients with MRSA bacteremia. J Infect Chemother. 2014;20(6):350-5.
• 17. Lawes T, Edwards B, Lopez-Lozano JM, Gould I. Trends in Staphylococcus aureus bacteraemia and impacts of infection control practices including universal MRSA admission screening in a hospital in Scotland, 2006-2010: retrospective cohort study and time-series intervention analysis. BMJ Open. 2012;2(3).