Turkiye Klinikleri Journal of Medical Sciences

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Staphylococcus aureus Suşlarında 10 Yıl Ara ile (2001-2011) Fusidik Asit Direnci
Fusidic Acid Resistance in Staphylococcus aureus Strains in an Interval of Ten Years (2001-2011)
Şebnem NERGİZa, Selahattin ATMACAa, Tuncer ÖZEKİNCİa, Alicem TEKİNa
aTıbbi Mikrobiyoloji AD, Dicle Üniversitesi Tıp Fakültesi, Diyarbakır
Turkiye Klinikleri J Med Sci. 2012;32(6):1668-72
doi: 10.5336/medsci.2011-27892
Article Language: TR
Full Text
ÖZET
 Amaç: Fusidik asit, metisiline dirençli suşlar da dahil olmak üzere stafilokokal enfeksiyonların tedavisinde tek başına veya ardışık olarak diğer antimikrobiyal ilaçlarla kombine edilerek kullanılan steroid benzeri bir antibiyotiktir. Bu çalışmada; 10 yıl ara ile hastanemiz klinik mikrobiyoloji laboratuvarında izole edilen Staphylococcus aureus [metisiline duyarlı Staphylococcus aureus (MSSA) ve metisiline dirençli Staphylococcus aureus (MRSA)] suşlarında fusidik asit direnç oranlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Suşların identifikasyonu için konvansiyonel yöntemler ve BD PhoenixTM otomatik mikrobiyoloji sistemi (BD Diagnostic Systems, Sparks, MD) kullanılmıştır. İdentifiye edilen S. aureus suşlarının metisilin ve fusidik asit duyarlılıkları Klinik ve Laboratuvar Standartları Enstitüsü (CLSI) önerileri doğrultusunda belirlenmiştir. Suşların metisilin duyarlılığını belirlemek amacıyla 1 µg oksasilin ve fusidik asit duyarlılığını belirlemek amacıyla da 10 µg fusidik asit içeren antibiyotik diskleri (Oxoid Ltd., Basingstoke, United Kingdom) kullanılmıştır. Oksasilin için inhibisyon zon çapı sınırları; ?13 mm ise duyarlı, 11-12 mm ise orta duyarlı, ≤10 mm ise dirençli olarak kabul edilmiş olup, CLSI kriterlerine göre saptanmıştır. Fusidik asit için inhibisyon zon çapı sınırları; ?22 mm ise duyarlı, 16-21 mm ise orta duyarlı, ≤15 mm ise dirençli olarak kabul edilmiş olup Fransa Mikrobiyoloji Cemiyeti'nin belirlediği kriterlere göre saptanmıştır. Bulgular: On yıl önce yapılan çalışmada S. aureus suşlarında fusidik asit direnci %11,6 iken, bu çalışmada %14,6 olarak saptanmıştır. İki direnç oranı arasında istatistiksel olarak anlamlı farklılık bulunmamıştır (p=0,695). Fusidik asit direnç oranları 2001 ve 2011 yıllarında MSSA suşlarında %4,2 ve %5,7, MRSA suşlarında ise %18,9 ve %22,2 olarak bulunmuştur. İki ayrı periyotta çalışılan MSSA ve MRSA suşlarının fusidik asit direncinde de istatistiksel olarak anlamlı farklılık bulunmamıştır (p=1,00, p=0,906). Sonuç: Elde ettiğimiz sonuçlar ışığında metisiline dirençli suşlar dahil tüm stafilokokal enfeksiyonların tedavisinde fusidik asidin halen iyi bir alternatif ilaç olabileceği görüşüne varılmıştır.

Anahtar Kelimeler: Fusidik asit; Staphylococcus aureus
ABSTRACT
 Objective: Fusidic acid is a steroid-like antibiotic which is used alone or consecutively in combination with other antimicrobial drugs in the treatment of staphylococcal infections, including the strains resistant to methicillin. In this study, we aimed to compare fusidic acid resistance rates in Staphylococcus aureus [methicillin susceptible Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA)] strains isolated in our hospital's clinical microbiology laboratory at an interval of ten years. Material and Methods: Bacterial strains were identified by conventional methods and BD PhoenixTM Automated Microbiology System (BD Diagnostic Systems, Sparks, MD). Methicillin and fusidic acid susceptibilities of the identified S. aureus strains were determined according to Clinical and Laboratory Standards Institute (CLSI) criteria. In order to determine methicillin and fusidic acid susceptibilities, 1 µg oxacillin and 10 µg fusidic acid disks (Oxoid Ltd., Basingstoke, United Kingdom) were used. Oxacillin susceptibility was detected according to the criteria of CLSI, and inhibition zone of ?13 mm was considered as sensitive, 11-12 mm as intermediate, ≤10 mm as resistant. Fusidic acid susceptibility was detected according to the criteria of Comite de L'antibiogramme de la Societe Française de Microbiologie, and inhibition zone of ?22 mm was considered as sensitive, 16-21 mm as intermediate, ≤15 mm as resistant. Results: In a study carried out ten years ago, fusidic acid resistance rate in S. aureus strains was reported as 11.6%, whereas in our study it was found as 14.6%. There was not any significant difference between the two resistance rates (p=0.695). Fusidic acid resistance rates were found to be 4.2% and 5.7%, respectively in the years 2001 and 2011 for MSSA strains. In MRSA strains, however, the rates were found as 18.9% and 22.2%, respectively. No significant difference was noted between fusidic acid resistances of MSSA and MRSA strains, studied at the two different periods (p=1.00, p=0.906). Conclusion: In the light of these findings, it has been concluded that fusidic acid is still a good alternative drug in the treatment of all staphylococcal infections, including methicillin resistant strains.

Keywords: Fusidic acid; Staphylococcus aureus

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