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Vojnosanitetski pregled
2008, vol. 65, br. 5, str. 377-382
jezik rada: srpski
vrsta rada: originalan članak
objavljeno: 29/07/2008
doi: 10.2298/VSP0805377P
Mehanizmi rezistencije Staphylococcus aureusa na meticilin
aZavod za javno zdravlje, Klinička mikrobiologija, Ćuprija
bVojnomedicinska akademija, Institut za mikrobiologiju, Beograd
cKlinički centar Srbije, Centar za prijem i zbrinjavanje urgentnih stanja – Urgentni centar, Beograd
dUniverzitet u Nišu, Medicinski fakultet, Katedra Mikrobiologija i imunologija

e-adresa: stibor@neobee.net

Sažetak

Uvod/Cilj. U mnogim bolnicama u svetu i kod nas rasprostranjenost meticilin-rezistentnog Staphylococcusa aureusa tako je velika da se u empirijskoj terapiji stafilokoknih infekcija koje ugrožavaju život bolesnika (sepsa, pneumonija) ne preporučuju beta-laktamski antibiotici, već se mora koristiti vankomicin. Cilj ovog rada bio je da se kod bolničkih i vanbolničkih izolata Staphylococcusa aureusa utvrdi produkcija beta-laktamaza, postojanje homogenog i heterogenog tipa rezistencije na meticilin, u slučaju granične rezistencije na meticilin utvrdi postojanje hiperprodukcije beta-laktamaza, kao i da se utvrdi statistička značajnost razlika u pogledu učestalosti ispitivanih mehanizama rezistencije kod bolničkih i vanbolničkih sojeva. Metode. Izolovano je i identifikovano 216 bolničkih i 186 vanbolničkih izolata Staphylococcusa aureusa. Za dokazivanje meticilinske rezistencije korišćen je disk-difuzioni test sa diskovima penicilina (10 IJ), oksacilina (1 μg) i cefoksitina (30 μg); produkcija beta-laktamaza ispitivana je nitrocefinskim testom, a minimalne inhibitorne koncentracije za oksacilin utvrđene su agar-dilucionom metodom. Rezultati. Rezistenciju na meticilin pokazalo je 56,5% bolničkih i 17,1% vanbolničkih stafilokoka (p < 0,05). Heterogeni tip rezistencije bio je češće zastupljen među bolničkim sojevima (18,1%) u odnosu na vanbolničke sojeve (7,2%) (p < 0,05). Produkcija betalaktamaza bila je u visokom procentu prisutna i kod bolničkih (97,5%) i kod vanbolničkih (95,5%) stafilokoka (p > 0,05). Procenat sojeva Staphylococcusa aureusa sa graničnom rezistencijom na meticilin (BORSA sojevi) iznosio je 4,3% među bolničkim i 3,4% među vanbolničkim stafilokokama (p > 0,05). Zaključak. Rezistencija na meticilin značajno je zastupljenija među izolatima Staphylococcusa aureusa bolničkog porekla, kao i heterogeni tip rezistencije. Procenat BORSA sojeva i produkcija beta laktamaza češći su u bolničkoj sredini, bez statističke značajnosti.

Ključne reči

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