L. Cochior, E. Miftode, D. Dorneanu, E. Năstase, D. Teodor, V. Luca
Spitalul Clinic de Boli Infecţioase Iaşi, U.M.F. Iaşi
Abstract
Introduction: The rate of Methicillin-resistance among staphylococcal strains is rising continually, affecting both the hospital-acquired strains and those responsible for community infections, with a large range of severity, from limited infections, bacteriemia with SIRS and systemic infections. Objectives: The aim of our study was to evaluate the clinical features of staphylococcal infections with methicillin-resistant (metiR) strains and the therapeutical choices of first line antibiotherapy, based on the presence of RFMR (risk factors for the acquisition of methicillin resistance): complication of a prior hospitalization, recent surgery, repeated hospitalizations, pacient living in institution, presence of catheters or prosthetic devices, prior antibiotherapy, auto medication. Matherial and method: We included in this study 125 cases of staphylococcal infections with metiR (methicillin-resistant) strains, diagnosed in the University Clinic of Infectious Diseases from October 2006 to October 2007. The identification was made by conventional methods and by using ID32Staph strips, the susceptibility to antibiotics being tested by difusimetric methods and by using the ATBStaph strips (bioMerieux, France). Results: We analyzed 125 cases of staphylococcal infections, 70c.(56%) with SA (Staphylococcus aureus) and 55 c.(44%) with SCN (coagulaze-negativ staphylococci), with a global rate of methicilline-resistance of 53,33% (67c.) : 50% in SA (35c.), 58% in SCN (32c.). In 65% cases we identified RFMR. Discordances between the first-line antibiotherapy, guided by the presence of RFMR and the results of antibiogramme were encountered in 38% cases, prominently sepsis with SCN. Conclusions: the rate of methicillin resistance reported by our study places us among the European countries with a high level of methicillin resistance. In 35% cases we found no history of FRMR, which correlates with the 38% cases of inadequate first line antibiotherapy. The efficient treatment was based on major antistaphylococcal agents (glycopeptides, linezolid) and fluoroquinolones. The clinical outcome was positive in 72% cases and worsened in 28% cases.