Öz
Giriş: Antibiyotikler, onlarca yıldır hayat kurtaran önemli bileşiklerdir. Ancak pek çok patojenik bakteri antibiyotiklere direnç kazanmaktadır. Makrolid-linkozamid-streptogramin B (MLSB) antibiyotik sınıflarında çapraz direnç morbidite artışına neden olabilmektedir. Bu çalışmada, metisilin-dirençli Staphylococcus aureus (MRSA) izolatlarında indüklenebilir klindamisin direncinin fenotipik ve genotipik dağılımı değerlendirilmektedir.
Gereç ve Yöntem: MRSA kökenlerinde eritromisin ile indüklenen klindamisin direnci, fenotipik olarak D-testi yoluyla ve genotipik olarak polimeraz zincir reaksiyonu ile doğrulandı.
Bulgular: Tüm MRSA izolatları eritromisine dirençliydi. İzolatlarda indüklenebilir iMLSB fenotipi (iMLSB: indüklenebilir makrolid, linkozamid streptogramin B) prevalansı %23,7 (9/38), makrolid streptogramin (MS) fenotipi prevalansı %47,4 (18/38) ve cMLSB (cMLSB: yapısal (constitutive) makrolid linkozamid streptogramin B) fenotipi prevalansı %28,9 (11/38) idi. iMLSB fenotipi gösteren dokuz köken, erm genleri açısından test edildi. ermA geni 5 (%55,6) izolatta, ermB geni 2 (%22,2) izolatta ve ermC geni 2 (%22,2) izolatta tespit edildi.
Sonuç: erm pozitif izolatlar iMLSB fenotipi göstermekteydi ve ermA geni baskındı. MRSA kökenlerinde cMLSB fenotipinin yaygın olduğunu ve klindamisin ile tedavide başarı sağlanabileceğini gösterdik. Bu çalışmada araştırılan erm genlerinin dağılımı, klindamisin tedavisinin başarısız olduğu olguların izlenmesinde D-testinin yeterliliğini göstermektedir.
Anahtar Kelimeler: ORSA, sefoksitin dirençli Staphylococcus aureus, linezolid, moleküler epidemiyoloji, oksasiline dirençli Staphylococcus aureus
Kaynakça
Carder M. The Rise in Antibiotic Resistance: A Cause for Concern. Microreviews in Cell and Molecular Biology. 2019;5:1-2.
MacLean RC, Millan AS. The evolution of antibiotic resistance. Science. 2019;365:1082-3.
Jackson KA, Gokhale RH, Nadle J, Ray SM, Dumyati G, Schaffner W, Ham DC, Magill SS, Lynfield R, See I. Public health importance of invasive methicillin-sensitive Staphylococcus aureus infections–surveillance in eight US counties, 2016. Clin Infect Dis. 2020;70:1021-8.
Petinaki E, Papagiannitsis K. Resistance of staphylococci to macrolideslincosamides- streptogramins B (MLSB): epidemiology and mechanisms of resistance. In: Staphylococcus aureus. Intech Open. 2018:117-33. Available from: https://www.intechopen.com/books/-i-staphylococcus-aureus-i-/ resistance-of-staphylococci-to-macrolides-lincosamides-streptograminsb- mlsb-epidemiology-and-mechan
Sarrou S, Malli E, Tsilipounidaki K, Florou Z, Medvecky M, Skoulakis A, Hrabak J, Papagiannitsis CC, Petinaki E. MLSB-resistant Staphylococcus aureus in Central Greece: rate of resistance and molecular characterization. Microbial Drug Resistance. 2019;25:543-50.
Yao W, Xu G, Li D, Bai B, Wang H, Cheng H, Zheng J, Sun X, Lin Z, Deng Q. Staphylococcus aureus with an erm-mediated constitutive macrolide-lincosamide-streptogramin B resistance phenotype has reduced susceptibility to the new ketolide, solithromycin. BMC Infect Dis. 2019;19:175.
Wendlandt S, Shen J, Kadlec K, Wang Y, Li B, Zhang W-J, Febler AT, Wu C, Schwarz S. Multidrug resistance genes in staphylococci from animals that confer resistance to critically and highly important antimicrobial agents in human medicine. Trends Microbiol. 2015;23:44-54.
Nawaz M, Khan S, Khan A, Khambaty F, Cermiglia C. Comparative molecular analysis of erythromycin-resistance determinants in staphylococcal isolates of poultry and human origin. Mol Cell Probes. 2000;14:311-9.
Szemraj M, Czekaj T, Kalisz J, Szewczyk EM. Differences in distribution of MLS antibiotics resistance genes in clinical isolates of staphylococci belonging to species: S. epidermidis, S. hominis, S. haemolyticus, S. simulans and S. warneri. BMC Microbiol. 2019;19:124.
Mama M, Aklilu A, Misgna K, Tadesse M, Alemayehu E. Methicillin-and Inducible Clindamycin-Resistant Staphylococcus aureus among Patients with Wound Infection Attending Arba Minch Hospital, South Ethiopia. Int J Microbiol. 2019;2019:2965490.
Sokoto (State, Nigeria) - Population Statistics, Charts, Map and Location. Last accessed date: 2019 Nov 1. Available from: https://citypopulation.de/ php/nigeria-admin.php?adm1id=NGA034
El-Mokhtar MA, Hetta HF. Ambulance vehicles as a source of multidrugresistant infections: a multicenter study in Assiut City, Egypt. Infect Drug Resist. 2018;11:587-94.
Kwoji ID, Jauro S, Musa JA, Lekko YM, Salihu SI, Danchuwa HA. Phenotypic detection of methicillin-resistant Staphylococcus aureus in village chickens from poultry markets in Maiduguri, Nigeria. J Adv Vet Anim Res. 2019;6:163-7.
Clinical & Laboratory Standards Institute (CLSI). CLSI Microbiology: 2018 AST Packages. Last accessed date: 2019 Sep 23. Available from: https://clsi. org/global-training-old/2018-ast-packages/
Godwin Nwokah E. Inducible-Clindamycin Resistance in Staphylococcus aureus isolates in Rivers State, Nigeria. AJCEM. 2016;4:50-5.
Siberry GK, Tekle T, Carroll K, Dick J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis. 2003;37:1257-60.
Bien H. QIAgen DNeasy Blood & Tissue kit, cultured cells. Last Accessed date: 2015. Available from: https://www.protocols.io/view/QIAgen-DNeasy- Blood-Tissue-kit-cultured-cells-dsz6f5
Untergasser A, Nijveen H, Rao X, Bisseling T, Geurts R, Leunissen JA. Primer3Plus, an enhanced web interface to Primer3. Nucleic Acids Res. 2007;35(Web Server issue):W71-4.
Ghanbari F, Ghajavand H, Havaei R, Jami M-S, Khademi F, Heydari L, Shahin M, Havaei S. Distribution of erm genes among Staphylococcus aureus isolates with inducible resistance to clindamycin in Isfahan, Iran. Adv Biomed Res. 2016;5:62.
Kaur DC, Chate SS. Study of Antibiotic Resistance Pattern in Methicillin Resistant Staphylococcus aureus with Special Reference to Newer Antibiotic. J Glob Infect Dis. 2015;7:78-84.
Ifeanyichukwu I, Chika E, Emmanuel N, Anthonia O, Ngozi A, Esther UI. Community acquired methicillin resistant Staphylococcus aureus (ca- MRSA) carriage amongst tertiary school students. AJST. 2015;2:18-21.
Gill J. Fitness costs of methicillin resistance in Staphylococcus aureus. Access Microbiology. 2019;1:62-73.
Dotel R, Tong SYC, Bowen A, Nelson JN, O’Sullivan MVN, Campbell AJ, McMullan BJ, Britton PN, Francis JR, Eisen DP, Robinson O, Manning L, Davis JS. CASSETTE-clindamycin adjunctive therapy for severe Staphylococcus aureus treatment evaluation: study protocol for a randomised controlled trial. Trials. 2019;20:353.
Kim BN, Kim ES, Oh MD. Oral antibiotic treatment of staphylococcal bone and joint infections in adults. J Antimicrob Chemother. 2014;69:309-22.
Wargo KA, McCreary EK, English TM. Vancomycin combined with clindamycin for the treatment of acute bacterial skin and skin-structure infections. Clin Infect Dis. 2015;61:1148-54.
Varada NL, Sakoulas G, Lei LR, Chua J. Agranulocytosis with ceftaroline high-dose monotherapy or combination therapy with clindamycin. Pharmacotherapy. 2015;35:608-12.
Gadekar D, Damle A. Detection of inducible clindamycin resistance in staphylococcal isolates from chronic suppurative otitis media. IJSR. 2019;8.
Goudarzi M, Eslami G, Rezaee R, Heidary M, Khoshnood S, Sajadi Nia R. Clonal dissemination of Staphylococcus aureus isolates causing nosocomial infections, Tehran, Iran. Iran J Basic Med Sci. 2019;22:238-45.
Rajak KC, Poddar CK, Kumar R, Jha AK. Inducible clindamycin resistant Staphylococcus aureus isolates from tertiary care hospital, Bettiah, India. J Evolution Med Dent Sci. 2018;7:3984-90.
Manandhar S, Singh A, Varma A, Pandey S, Shrivastava N. Biofilm Producing Clinical Staphylococcus aureus Isolates Augmented Prevalence of Antibiotic Resistant Cases in Tertiary Care Hospitals of Nepal. Front Microbiol. 2018; 9: 2749.
Coutinho V de LS, Paiva RM, Reiter KC, de-Paris F, Barth AL, Machado ABMP. Distribution of erm genes and low prevalence of inducible resistance to clindamycin among staphylococci isolates. Braz J Infect Dis. 2010;14:564-8.
Lewis JS, Jorgensen JH. Inducible Clindamycin Resistance in Staphylococci: Should Clinicians and Microbiologists be Concerned? Clin Infect Dis. 2005;40:280-5.
Magi G, Marini E, Facinelli B. Antimicrobial activity of essential oils and carvacrol, and synergy of carvacrol and erythromycin, against clinical, erythromycin-resistant Group A Streptococci. Front Microbiol. 2015;6.
