Hoşgör Limoncu Mine, Ermertcan Satak, Taşli Hüseyin, Kurutepe Semra
Ege Universitesi Eczacilik Fakültesi, Farmasötik Mikrobiyoloji Anabilim Dali, Izmir.
Mikrobiyol Bul. 2007 Oct;41(4):511-6.
The emergence of Staphylococcus aureus strains with intermediate resistance (VISA) and heterogen resistance (hVISA) to vancomycin leads to the occurence of severe therapeutic problems. The aim of this study was to investigate the vancomycin resistance in methicillin resistant S. aureus (MRSA) and coagulase-negative staphylococci (MRCoNS) isolated from clinical samples in Bacteriology Laboratory of Microbiology and Clinical Microbiology Department of Celal Bayar University Faculty of Medicine, Manisa (located in western Anatolia, Turkey). A total of 120 staphyloccoccal strains (92 MRSA and 28 MRCoNS) isolated from different clinical specimens (tracheal aspirate, blood, abscess, wound swabs, sputum, catheter tips, etc) between the period of June 2005 to December 2006 were included to the study. Vancomycin resistance were determined by agar screening method using brain hearth infusion agar plates containing 6 microg/mL vancomycin. Standard E-test and macro E-test methods were performed for 17 (14%) staphylococcal strains (10 MRSA and 7 MRCoNS) which had grown in agar screening plates. Vancomycin and teicoplanin minimal inhibitory concentration (MIC) ranges of those strains were found as 1.5-4 microg/mL and 2-4 microg/mL, respectively, by standard E-test method. In our study, no VISA and hVISA isolates were detected when MIC value of > or =8 microg/mL for vancomycin and teicoplanin, or > or =12 microg/mL for teicoplanin only were accepted as the criteria for hVISA determination. Agar screening method which is preferably used in routine laboratories for practical and economical reasons, lower sensitivity and specificity than E-test. It can be concluded that, since agar screening method is not reliable for the detection of vancomycin resistance, further multi-center studies with the use of standard methods are needed in order to clarify the vancomycin resistance patterns of staphylococci in our country.
对万古霉素具有中度耐药性（VISA）和异质性耐药性（hVISA）的金黄色葡萄球菌菌株的出现导致了严重治疗问题的发生。本研究的目的是调查从位于土耳其安纳托利亚西部马尼萨的切拉尔·巴亚尔大学医学院微生物学和临床微生物学系细菌学实验室的临床样本中分离出的耐甲氧西林金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCoNS）中的万古霉素耐药性。2005年6月至2006年12月期间，从不同临床标本（气管吸出物、血液、脓肿、伤口拭子、痰液、导管尖端等）中分离出的总共120株葡萄球菌菌株（92株MRSA和28株MRCoNS）被纳入该研究。使用含有6μg/mL万古霉素的脑心浸液琼脂平板通过琼脂筛选法测定万古霉素耐药性。对在琼脂筛选平板上生长的17株（14%）葡萄球菌菌株（10株MRSA和7株MRCoNS）进行了标准E-test和宏E-test方法检测。通过标准E-test方法，这些菌株的万古霉素和替考拉宁最低抑菌浓度（MIC）范围分别为1.5 - 4μg/mL和2 - 4μg/mL。在我们的研究中，当将万古霉素和替考拉宁的MIC值≥8μg/mL或仅替考拉宁的MIC值≥12μg/mL作为hVISA测定标准时，未检测到VISA和hVISA分离株。由于实际和经济原因，琼脂筛选法在常规实验室中更常用，但其灵敏度和特异性低于E-test。可以得出结论，由于琼脂筛选法检测万古霉素耐药性不可靠，因此需要进一步开展使用标准方法的多中心研究，以明确我国葡萄球菌的万古霉素耐药模式。
