Öz
Giriş: Staphylococcus aureus kökenlerinde metisilin direncinin hızlı ve doğru bir şekilde belirlenmesi hayati öneme sahiptir. Bu çalışmada, mecA/mecC pozitifliği altın standart kabul edilerek, sefoksitin disk difüzyon (CDD) testinin ve BD Phoenix otomatize sisteminin duyarlılık ve özgüllüklerinin karşılaştırılması ve S. aureus kökenlerinin önemli bir virülans faktörü olan Panton-Valentine lökosidin (PVL) toksin geni varlığının araştırılması amaçlandı.
Gereç ve Yöntem: Çeşitli klinik örneklerden elde edilmiş toplam 179 S. aureus suşu çalışmaya dahil edildi. Antibiyotik duyarlılığı, Phoenix otomatize sistemi ve sefoksitin (30 µg) için Kirby-Bauer disk difüzyon yöntemi uygulanarak test edildi. mecA, mecC ve PVL genlerinin varlığı konvansiyonel multipleks polimeraz zincir reaksiyonu yöntemi kullanılarak belirlendi. mecA/mecC pozitifliği altın standart olarak kabul edildi. İstatistiksel analiz için SPSS 15.0 (Chicago, IL, USA) for Windows programı kullanıldı.
Bulgular: mecA geni içeren doksan bir köken (%50,8) metisiline dirençli Staphylococcus aureus (MRSA) olarak tanımlandı. mecC geni içeren hiçbir izolat tespit edilmedi. Phoenix otomasyon sistemi mecA ve mecC negatif olan altı metisiline duyarlı S. aureus (MSSA) izolatını yanlışlıkla MRSA olarak tanımladı. MRSA’nın belirlenmesinde CDD testinin duyarlılığı ve özgüllüğü %100, otomatize sistemin duyarlılığı ve özgüllüğü ise sırasıyla %100 ve %93,2 olarak bulundu. MRSA ve MSSA suşlarında PVL pozitifliği sırasıyla %6,5 ve %7,4 idi. Panton-Valentine lökosidin pozitif tüm suşlar deri ve yumuşak doku örneklerinden izole edildi.
Sonuç: Sefoksitin disk difüzyon testi, rutin prosedürde kullanılabilecek güvenilir bir yöntemdir. Metisiline duyarlı suşlar Phoenix sistemi ile metisiline dirençli saptanabilir. Metisilin direncinin belirlenmesinde kullanılan yöntemlerin mecC ilişkili MRSA’ları gözden kaçırmaması gerekir. Panton-Valentine lökosidin toksin geni, klinisyeni enfeksiyonun ciddiyeti konusunda uyarması açısından belirlenmelidir.
Anahtar Kelimeler: mecA, mecC, ORSA, Kirby-Bauer testi, moleküler epidemiyoloji
Kaynakça
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