Yurtta kalan öğrencilerde toplumsal kaynaklı metisilin dirençli (TK-MRSA) ve indüklenebilir dormant metisilin dirençli stapylococcus aureus (ID-MRSA) taşıyıcılığının ve taşıyıcılarda üreyen suşlarda klonal ilişkinin araştırılması
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Dosyalar
Tarih
2013
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Yayıncı
Selçuk Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Stapylococcus aureus hastane ve toplumsal kaynaklı enfeksiyonlara neden olan önemli bir insan patojenidir. İnsanların yaklaşık %30?u S. aureus?u burunda ve vücudun diğer kısımlarında taşırlar. Bu çalışmanın amacı, indüklenebilir dormant metisilin dirençli S. aureus?un üniversite öğrencilerindeki burun kolonizasyonunu belirlemektir. Sağlıklı öğrencilerin burun kültürleri alındı. S. aureus?a benzeyen tüm koloniler konvansiyonel yöntemler ve stapyloslide lateks test ile tanımlandı (Becton Dickinson, Sparks, USA). Antibiyotik duyarlılık testleri ve metisilin direnci Kirby-Bauer disk difüzyon yöntemi ile CLSI önerileri doğrultusunda belirlendi. Vankomisin duyarlılığı E-test ile araştırıldı. Tüm S. aureus?larda mecA genleri varlığı PCR ile belirlendi. SCCmec tipleri ise türe özgü primerlerin kullanılması ile tespit edildi. MRSA?ların klonal ilişkisi PFGE yöntemi ile araştırıldı. Araştırmaya alınan 1108 öğrenciden %17 (n=192)?sinin S. aureus ile kolonize olduğu görüldü. İzolatların %91 (n=175)?i metisiline duyarlı, %9 (n=17)?u metisiline dirençli olarak bulundu. S. aureus?lardan %91 (n=175)?inin mecA geni negatif (MSSA), %9 (n=17)?unun mecA geni pozitif bulundu. Metisiline duyarlı olup mecA geni pozitif olan suş yani indüklenebilir dormant metisilin direnci bulunamadı. İzolatlardan 2?sinin SCCmec tip III, 11?inin SCCmec varyant IIIA ve 1?inin SCCmec tip IV olduğu tespit edildi. mecA pozitif olan 3 örneğin ise SCCmec sınıflandırması yapılamadı. Tüm suşlar vankomisine duyarlı bulundu. S. aureus?un diğer antibiyotiklere duyarlılıkları trimetoprim / sulfametoksazol için %97.4, linezolid ve levofloksasin için %99, klindamisin için %95.3, tetrasiklin ve gentamisin için %92.2, eritromisin için %84.9 ve penisilin için %22.4 bulundu. PFGE ile 5 pulsotip (klon) (A-E) saptandı. Suşların ikisinin A pulsotipi, dokuzunun B pulsotipi, ikisinin C, birinin D ve üçünün E pulsotipine ait olduğu belirlendi. En geniş pulsotipi B pulsotipi oluşturmaktaydı (%52.9). B pulsotipindeki 9 izolatın 5?i B1 ve 4?ü B2 olarak tanımlandı. B pulsotipindeki 9 izolatın 5?i B1 ve 4?ü B2 olarak tanımlandı. B pulsotipindeki 9 izolatın 6?sı tıp öğrencilerinden 3?ü yurtta kalan diğer öğrencilerden izole edildi ve bunların anket sonuçları incelendiğinde hastanede yatma öykülerinin olduğu görüldü. B pulsotipine ait olarak belirlenen suşların hastane kökenli olduğu düşünüldü. MRSA taşıyıcılığı oranı tıp fakültesi öğrencilerinde, yurtta kalan öğrencilere oranla daha yüksek saptanmıştır. Hastanede bulunmanın MRSA taşıyıcılığı açısından risk olduğu saptanmıştır. Hastane personeli koruyucu önlemler konusunda eğitilmelidir. Hastane ve toplum temelli sürveyans çalışmalarının ve izolatların moleküler mikrobiyolojik analizinin yapılması MRSA epidemiyolojisinin ve evriminin anlaşılmasını sağlayacaktır.
Staphylococcus aureus is an important human pathogen causing both hospital and community acquired infections. Approximately 30% of people carry S. aureus in the anterior nares and on the other parts of their body. The aim of this study was to determine nasal colonization of university students with inducible dormant and methicillin-resistant S. aureus. Nasal surveillance cultures were performed in healthy students. All colonies resembling S. aureus were identified by conventional methods and Staphyloslidelatex test (BectonDickinson, Sparks, USA). Antibiotic susceptibility tests and oxacillin resistance were determined by Kirby-Bauer disk diffusion method as recommended by CLSI. Vancomycin susceptibility was investigated by E-test. All S. aureus isolates were investigated by PCR for the presence of the mecA gene. SCCmec types were determined by the use of specific primers. Clonal relation of MRSA strains was investigated by PFGE method. Of the 1108 university students, 17% (n=192) was colonized by S. aureus. Of the isolates 91% (n=175) was methicillin susceptible, 9% (n=17)was methicillin resistant. Ninety one percent (n=175) of S. aureus was mecA gene-negative (MSSA), while 9% (n= 7)was mecA gene-positive. Inducible dormant MRSA was not investigated because methicillin-susceptible mecA-positive S. aureus isolate was not detected. Of the isolates, 2 were harboring SCCmec type III, 11 SCCmec variant IIIA, and 1 SCCmec type IV. Three isolates which were mecA gene positive could not be classified in any of theSCCmec types. All strains were susceptible to vancomycin. The susceptibilities of S. aureus strains for other antibiotics were found 99% for trimethoprim/sulfamethoxazole 97.4% forlinezolid and levofloxacin, 95.3 % forclindamycin, 92.2% for tetracycline and gentamicin, 84.9% for erythromycin and 22.4 % for penicillin. We determined 5 pulsotypes (clone)(-E) by PFGE. Of the 16 species pulsotpe A was determined in 2, pulsotype B in 9, pulsoype C in 2, pulsotype D in 1, pulsotype E in 3 species.The largest pulsotype was pulsotype B (52.9%). Five of the 9 species in pulsotype B was defined as B1 and 4 ofthem was defined as B2. 6 of the species out of 9 in pulsotype B were isolated from medical stı-udents and 3 of them from the university students living at youth hostels and all of these 3 students had the history of hospitalization. We thougt that all of the strains in B pulsotye were hospital acquired. MRSA carriage in medical university students appears high as compared to the university students living at youth hostels. Being in hospital was determined as a risk factor for MRSA carriage. University healthcare personnel should be educated about preventive measures needed to avoid outbreaks. Doing surveliance studies and the molecular analysis of the species isolated in hospitals and community will provide the understanding of the epidemiology and the evolution of the MRSA
Staphylococcus aureus is an important human pathogen causing both hospital and community acquired infections. Approximately 30% of people carry S. aureus in the anterior nares and on the other parts of their body. The aim of this study was to determine nasal colonization of university students with inducible dormant and methicillin-resistant S. aureus. Nasal surveillance cultures were performed in healthy students. All colonies resembling S. aureus were identified by conventional methods and Staphyloslidelatex test (BectonDickinson, Sparks, USA). Antibiotic susceptibility tests and oxacillin resistance were determined by Kirby-Bauer disk diffusion method as recommended by CLSI. Vancomycin susceptibility was investigated by E-test. All S. aureus isolates were investigated by PCR for the presence of the mecA gene. SCCmec types were determined by the use of specific primers. Clonal relation of MRSA strains was investigated by PFGE method. Of the 1108 university students, 17% (n=192) was colonized by S. aureus. Of the isolates 91% (n=175) was methicillin susceptible, 9% (n=17)was methicillin resistant. Ninety one percent (n=175) of S. aureus was mecA gene-negative (MSSA), while 9% (n= 7)was mecA gene-positive. Inducible dormant MRSA was not investigated because methicillin-susceptible mecA-positive S. aureus isolate was not detected. Of the isolates, 2 were harboring SCCmec type III, 11 SCCmec variant IIIA, and 1 SCCmec type IV. Three isolates which were mecA gene positive could not be classified in any of theSCCmec types. All strains were susceptible to vancomycin. The susceptibilities of S. aureus strains for other antibiotics were found 99% for trimethoprim/sulfamethoxazole 97.4% forlinezolid and levofloxacin, 95.3 % forclindamycin, 92.2% for tetracycline and gentamicin, 84.9% for erythromycin and 22.4 % for penicillin. We determined 5 pulsotypes (clone)(-E) by PFGE. Of the 16 species pulsotpe A was determined in 2, pulsotype B in 9, pulsoype C in 2, pulsotype D in 1, pulsotype E in 3 species.The largest pulsotype was pulsotype B (52.9%). Five of the 9 species in pulsotype B was defined as B1 and 4 ofthem was defined as B2. 6 of the species out of 9 in pulsotype B were isolated from medical stı-udents and 3 of them from the university students living at youth hostels and all of these 3 students had the history of hospitalization. We thougt that all of the strains in B pulsotye were hospital acquired. MRSA carriage in medical university students appears high as compared to the university students living at youth hostels. Being in hospital was determined as a risk factor for MRSA carriage. University healthcare personnel should be educated about preventive measures needed to avoid outbreaks. Doing surveliance studies and the molecular analysis of the species isolated in hospitals and community will provide the understanding of the epidemiology and the evolution of the MRSA
Açıklama
Anahtar Kelimeler
MRSA, PFGE, ID-MRSA, Nose, Burun, Hastalık, Disease, Metisilin, Methicillin, Polimeraz zincirleme reaksiyonu, Polymerase chain reaction, Staphylococcus aureus, Öğrenciler, Students, Üniversite öğrencileri, University students
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Künye
Demirel, G. (2013). Yurtta kalan öğrencilerde toplumsal kaynaklı metisilin dirençli (TK-MRSA) ve indüklenebilir dormant metisilin dirençli stapylococcus aureus (ID-MRSA) taşıyıcılığının ve taşıyıcılarda üreyen suşlarda klonal ilişkinin araştırılması. Selçuk Üniversitesi, Yayımlanmış yüksek lisans tezi, Konya.
