Toplum Kökenli Enfeksiyonlarda Direnç ve Tedavi: Deri Yumuşak Doku Enfeksiyonları bir yer tutmaktadır. Hastane kökenli MRSA suşları uzun zamandır tedavideki güçlükler nedeniyle sorun olmaya devam etmektedir. 1990 yılından beri toplumda hızla yayılan MRSA suşları özellikle deri ve yumuşak doku enfeksiyonlarına neden olmaktadır. Toplum kökenli suşlar beta-laktam antibiyotiklere dirençli olmakla birlikte birçok antibakteriyele karşı düşük direnç göstermektedir. Sık görülen S. aureus enfeksiyonlarının tedavisinde bu durum göz önünde bulundurulmalıdır. Hastane kökenli ve toplum kökenli MRSA suşlarının epidemiyolojik ve moleküler çalışmalar sonucunda oldukça büyük farklılıklar gösterdiği ortaya konulmuştur. Bu kökenlerin özellikleri ve toplum kökenli MRSA risk faktörleri Tablo 6’da gösterilmiştir. KAYNAKLAR 1. Baba T, Takeuchi F, Kuroda M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet 2002;359:1819-27. 2. Chambers HF. Management of skin and soft-tissue infection. N Engl J Med 2008;359:1063-7. 3. Craft N, Lee PK, Zipoli MT, et al. Superficial cutaneous infection and pyodermas. In: Wolff K, Goldsmith LA, Katz SI (eds). Fitzpatrick’s Dermatology in General Medicine. 7 th ed. McGraw-Hill, 2008:1694-709. 4. Demidovich CW, Wittler RR, Ruff ME, Bass JW, Browning WC. Impetigo: Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies. Am J Dis Child 1990;144:1313-5. 5. Dietrich DW, Auld DB, Mermel LA. Community-acquired MRSA in Southern New England children. Pediatrics 2004;113:347-52. 6. Eke N. Fournier’s gangrene: A review of 1726 cases. Br J Surg 2000;87:718-28. 7. Farley JE. Epidemiology, clinical manifestations, and treatment options for skin and soft tissue infection caused by community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Nurse Pract 2008;20:85-92. 8. File TM, Stevens DL. Methicillin-resistant Staphylococcus aureus (MRSA) infections. Skin and Soft-Tissue Infections. 2 nd ed. Pennsylvania: Handbooks in Health Care Company, 2008:17-27. 9. File TM, Stevens DL. Necrotizing soft-tissue infections. Skin and Soft-Tissue Infections. 2 nd ed. Pennsylvania: Handbooks in Health Care Company, 2008:117-35. 16 10. Hammond SP, Baden LR. Management of skin and softtissue infection-polling results. N Engl J Med 2008;359:20. 11. Hirschmann JV. Impetigo: Etiology and therapy. Curr Clin Top Infect Dis 2002;22:42-51. 12. Ito T, Katayama Y, Asada K, et al. Structural comparison of three types of staphylococcal cassette chromosome mec integrated in the chromosome in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2001;45:1323-36. 13. Lew DP, Southwick FS. Skin and soft tissue infection. In: Southwick FS (ed). Infectious Diseases A Clinical Short Course. 2 nd ed. McGraw-Hill, 2007:256-72. 14. Lewis RT. Necrotizing soft-tissue infections. Infect Dis Clin North Am 1992;6:693-703. 15. Lipsky BA, Pecoraro RE, Ahroni JH, Peugeot RL. Immediate and longterm efficacy of systemic antibiotics for eradicating nasal colonization with Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1992;11:43-7. 16. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976-84. 17. Noskin GA. Methicillin-resistant Staphylococcus aureus. Antimicrobial-Resistant Bacteria. 2 nd ed. Pennsylvania: Handbooks in Health Care Company, 2008:68-100. 18. Pasternak MS, Swartz MN. Cellulitis and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 6 th ed. Philadelphia: Chirchill Livingstone, 2005. 19. Saavedra A, Weinberg AN, Swartz MN, Johnson RA. Soft-tissue infections: Erysipelas, cellulitis, gangrenous cellulitis and myonecrosis. In: Wolff K, Goldsmith LA, Katz SI (eds). Fitzpatrick’s Dermatology in General Medicine. 7 th ed. McGraw-Hill, 2008:1720-31. 20. Sosin DM, Gunn RA, Ford WL, Skaggs JW. An outbreak of furunculosis among high school athletes. Am J Sports Med 1989;17:828-32. 21. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and Soft-Tissue Infections. Clin Infect Dis 2005;41:1373- 406. 22. Vandenesch F, Naimi T, Enright MC, et al. Community acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: Worldwilde emergence. Emerg Infect Dis 2003;9:978-84. 23. Zimakoff J, Rosdahl VT, Petersen W, Scheibel J. Recurrent staphylococcal furunculosis in families. Scand J Infect Dis 1988;20:403-5. 2. Türkiye <strong>EKMUD</strong> Bilimsel Platformu 2009
2. Türkiye <strong>EKMUD</strong> Bilimsel Platformu 11-14 Mart 2009, Bilkent Otel ve Konferans Merkezi, Ankara Toplum Kökenli Enfeksiyonlarda Direnç ve Tedavi: Üriner Sistem Enfeksiyonlar› Dr. Nazif Elald› Cumhuriyet Üniversitesi T›p Fakültesi Enfeksiyon Hastal›klar› ve Klinik Mikrobiyoloji Anabilim Dal› Sivas 17