Ortopedik Cerrahi Alan Enfeksiyonlarından İzole Edilen Staphylococcus aureus’larda Panton-Valentine Lökosidin Varlığının Araştırılması
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Dosyalar
Tarih
2018
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Yayıncı
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info:eu-repo/semantics/openAccess
Özet
Öz: Staphylococcus aureus insanlarda özellikle ortopedik cerrahi sonrasında, cerrahi alan enfeksiyonları (CAE)’na neden olan en önemli mikroorganizmalardan biridir. Panton-Valentine lökosidin (PVL) nekroz veya apoptozis ile polimorfonükleer hücrelerde harabiyete neden olduğundan, S.aureus’un virülansında büyük önem taşımaktadır. PVL pozitif S.aureus izolatlarının yayılımı, CAE’lerde morbidite ve mortalitenin artmasında önemli bir faktör olabileceğinden dolayı kaygı vericidir. Bu çalışmada, ortopedi ve travmatoloji servisinde ortopedik cerrahi sonrasında CAE gelişen hastalardan elde edilen S.aureus izolatlarında PVL varlığının araştırılması ve PVL varlığının hastanın klinik durumuna yansımasının irdelenmesi amaçlanmıştır. 2013-2017 yılları arasında ortopedik cerrahi sonrasında S.aureus’a bağlı CAE gelişmiş 101 hasta çalışmaya alınmıştır. İzolatların tanımlanması konvansiyonel yöntemler ve “Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS)” ile yapılmıştır. Metisilin direnci sefoksitin diski kullanılarak Kirby-Bauer disk difüzyon yöntemi ve otomatize sistem (Vitek 2, bioMérieux, Fransa) ile belirlenmiştir. PVL gen bölgesi Luk-PV-1 ve Luk-PV-2 primerleri kullanılarak polimeraz zincir reaksiyonu (PCR) yöntemiyle araştırılmıştır. Hastalara ait yatış süreleri, C-reaktif protein (CRP), sedimentasyon düzeyleri ve klinik durumu retrospektif olarak hastane bilgi sisteminden elde edilmiştir. İzolatların 15 (%14.9)’i metisiline dirençli S.aureus (MRSA), 86 (%85.1)’sı metisiline duyarlı S.aureus (MSSA) olarak belirlenmiştir. On dört (%13.9) izolatta (3 MRSA, 11 MSSA) PVL pozitifliği saptanmıştır. PVL negatif hastaların hastanede yatış süresi ortalama 17 (5-73) gün, PVL pozitif hastalarda ortalama 46 (21-103) gün olarak belirlenmiştir. PVL negatif hastalarda serolojik belirteçlerden CRP’nin 5-7, sedimentasyonun 40-60 arasında seyrettiği, PVL pozitif hastalarda ise CRP’nin 11-20, sedimentasyonun 90-110 arasında seyrettiği gözlemlenmiştir. PVL negatif hastalarda serolojik belirteçler 7-10 günde düzelirken, PVL pozitif hastalarda bu sürenin 17-32 güne kadar uzadığı belirlenmiştir. Altı hastada osteomiyelit gelişirken osteomiyelit gelişen hastalardan ikisi PVL pozitif MRSA, biri PVL pozitif MSSA, üçü ise PVL negatif MRSA olarak saptanmıştır. PVL pozitif MRSA ile osteomiyelit gelişen hastalardan ikisinin ortopedik CAE’lerinde PVL gen bölgesine sahip S.aureus izolatları gözlemlenmiştir. Bu çalışmada, PVL gen bölgesine sahip S.aureus izolatlarının, hastanede yatış ve serolojik göstergelerin düzelme süreleri dışında mortaliteyi de artırdığı belirlenmiştir. CAE gelişen hastalarda, PVL pozitif S.aureus izolasyonu endişe vericidir. Bu nedenle, hastane ortamında bu izolatların yayılımını önleyecek tedbirlerin ve uygulamaların hayata geçirilmesi için gerekli enfeksiyon kontrol önlemlerinin alınmasının yararlı olacağı kanısındayız.
Öz: Staphylococcus aureus is one of the most clinically important bacteria causing infection in humans. It is an important pathogen in surgical site infections (SSIs), especially after orthopedic surgery. Pantonevalentine leukocidin (PVL) has a great importance in the virulence of S.aureus because it can destroy polymorphonuclear cells by necrosis or apoptosis. The spread of PVL positive S.aureus is a great concern, since it may become an important factor for increased morbidity and mortality in SSIs, especially after surgery. In this study, we aimed to investigate the presence of PVL in S.aureus strains isolated from patients who had surgical site infections after orthopedic surgery, and also the clinical status of these patients. Between 2013 and 2017, 101 patients who had SSIs due to S.aureus after orthopedic surgery were included in the study. Identification of the strains was determined by conventional methods and “Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry” (MALDI-TOF MS). Methicillin resistance was determined by Kirby-Bauer disc diffusion method and automated system (Vitek 2, bioMérieux, France). The PVL gene region was investigated by polymerase chain reaction (PCR) method by using the primers Luk-PV-1 and Luk-PV-2. The duration of the patients’ hospitalization, C-reactive protein (CRP) and sedimentation levels and clinical status were obtained from the hospital information system, retrospectively. Fifteen (14.9%) of the isolates were methicillin resistance S.aureus (MRSA) and 86 (85.1%) were methicillin susceptibility S.aureus (MSSA). PVL positivity was detected in 14 (13.9%) isolates (3 MRSA, 11 MSSA). The mean hospital stays in PVL-negative patients were 17 (5-73) days and 46 (21-103) days in PVL-positive patients. It was observed that the serologic markers CRP and sedimentation were between 5-7 and 40-60 in PVL negative patients, and between 11-20 and 90-110 in PVL positive patients, respectively. In PVL-negative patients, serologic markers improved in 7-10 days, while in PVL-positive patients they were improved in 17-32 days. Osteomyelitis occurred in six patients (2 PVL positive MRSA, 1 PVL positive MSSA and 3 PVL negative MRSA). In two of the patients who have developed osteomyelitis with PVL-positive MRSA, PVL gene positive S.aureus isolates were observed in their orthopedic SSIs. We also determined that these isolates increased the hospitalization days, improvement time of serological markers and mortality. It is worrisome to isolate PVL-positive S.aureus strains in SSIs. Therefore, we believe that it would be useful to take infection control measures to prevent the spread of these strains in the hospital setting.
Öz: Staphylococcus aureus is one of the most clinically important bacteria causing infection in humans. It is an important pathogen in surgical site infections (SSIs), especially after orthopedic surgery. Pantonevalentine leukocidin (PVL) has a great importance in the virulence of S.aureus because it can destroy polymorphonuclear cells by necrosis or apoptosis. The spread of PVL positive S.aureus is a great concern, since it may become an important factor for increased morbidity and mortality in SSIs, especially after surgery. In this study, we aimed to investigate the presence of PVL in S.aureus strains isolated from patients who had surgical site infections after orthopedic surgery, and also the clinical status of these patients. Between 2013 and 2017, 101 patients who had SSIs due to S.aureus after orthopedic surgery were included in the study. Identification of the strains was determined by conventional methods and “Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry” (MALDI-TOF MS). Methicillin resistance was determined by Kirby-Bauer disc diffusion method and automated system (Vitek 2, bioMérieux, France). The PVL gene region was investigated by polymerase chain reaction (PCR) method by using the primers Luk-PV-1 and Luk-PV-2. The duration of the patients’ hospitalization, C-reactive protein (CRP) and sedimentation levels and clinical status were obtained from the hospital information system, retrospectively. Fifteen (14.9%) of the isolates were methicillin resistance S.aureus (MRSA) and 86 (85.1%) were methicillin susceptibility S.aureus (MSSA). PVL positivity was detected in 14 (13.9%) isolates (3 MRSA, 11 MSSA). The mean hospital stays in PVL-negative patients were 17 (5-73) days and 46 (21-103) days in PVL-positive patients. It was observed that the serologic markers CRP and sedimentation were between 5-7 and 40-60 in PVL negative patients, and between 11-20 and 90-110 in PVL positive patients, respectively. In PVL-negative patients, serologic markers improved in 7-10 days, while in PVL-positive patients they were improved in 17-32 days. Osteomyelitis occurred in six patients (2 PVL positive MRSA, 1 PVL positive MSSA and 3 PVL negative MRSA). In two of the patients who have developed osteomyelitis with PVL-positive MRSA, PVL gene positive S.aureus isolates were observed in their orthopedic SSIs. We also determined that these isolates increased the hospitalization days, improvement time of serological markers and mortality. It is worrisome to isolate PVL-positive S.aureus strains in SSIs. Therefore, we believe that it would be useful to take infection control measures to prevent the spread of these strains in the hospital setting.
Açıklama
Anahtar Kelimeler
Kaynak
Mikrobiyoloji Bülteni
WoS Q Değeri
Q4
Scopus Q Değeri
Q4
Cilt
52
Sayı
4
Künye
DUMAN Y,SEVİMLİ R (2018). Ortopedik Cerrahi Alan Enfeksiyonlarından İzole
Edilen Staphylococcus aureus’larda Panton-Valentine
Lökosidin Varlığının Araştırılması. Mikrobiyoloji Bülteni, 52(4), 340 - 347. Doi: 10.5578/mb.67328
