Geç dönemde hastanede gelişen pnömoni etkenlerinin hızlı moleküler biyolojik yöntemler ile saptanması
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Dosyalar
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Hastaneye yatışı takip eden 5. günden sonra ortaya çıkan geç dönemde hastanede gelişen pnömonilere (HGP) genellikle çok ilaca dirençli bakteriler neden olmaktadır. Etkenlerin geç saptanması, uygun antibiyotiğin zamanında başlanamaması HGP prognozunu olumsuz olarak etkilemektedir. Son yıllarda enfeksiyon etkeni mikroorganizmaların hızlı moleküler yöntemlerle kısa sürede izole edilmesi, tedavinin daha erken ve etkin olarak başlanmasını sağlamaktadır. Bu durumun prognozu olumlu yönde etkileyeceği düşünülmektedir. Bu çalışmada, HGP'de etkenlerin hızlı moleküler yöntemlerle saptanması ve sonuçların konvansiyonel yöntemlerle karşılaştırılması amaçlanmıştır. Gereç-Yöntem: Ocak 2014 ile Ocak 2016 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Göğüs Hastalıkları ile Anestezi ve Reanimasyon yoğun bakım ünitelerinde izlenen ve 2005 yılında yayınlanan ATS-IDSA kriterlerine göre HGP tanısı alan 62 hasta çalışmaya alınmıştır. HGP tanısı konulduğu anda hastalardan bronkoskopik (BAL, BASP) ve nonbronkoskopik (mini-BAL) yöntemlerle alt solunum yolu örnekleri alınmıştır. Alınan örnekler hem konvansiyonel yöntemler ve hem de hızlı moleküler yöntemlerle bakteriyolojik etkenler açısından incelenmiştir. Bulgular: Hasanede gelişen pnömoni tanısı alan 62 hasta (42 erkek, yaş ortalaması 69.7±15.6) alınmıştır. Hastaların %95.2'sinde ek hastalık olup, 33 hastaya invaziv mekanik vetilasyon (İMV), 28 hastaya İMV + noninvaziv mekanik ventilasyon (NİV) uygulanmıştır. Hastanede gelişen pnömoni tanısı anında 59 hastanın 39'inin akciğer grafisinde tek taraflı infiltrasyon, 20'sinde çift taraflı infiltrasyon saptanmıştır. Üç hastanın akciğer grafisinde ise tek taraflı infiltrasyon yanısıra plevral efüzyon uyumlu dansite artışı izlenmiştir. Konvansiyonel yöntem ile 62 hastanın 40'ında (%64.5) bakteriyel etken saptanırken, polimeraz zincir reaksiyon (PCR) ile 62 hastanın 57'sinde (%91.9) bakteriyel etken izole edilmiştir. Etken saptanması açısından konvansiyonel yöntem ile PCR yönteminin birbiriyle uyumlu olduğu gözlenmiştir (kappa:0.797). Ayrıca, PCR ile etken saptanma oranının anlamlı olarak yüksek olduğu görülmüştür (p=0.0004). Her iki yöntem ile en sık Acinetobacter baumannii saptanmıştır. İzlemde 62 hastanın 45'inde (% 72.6) mortalite izlenmiştir. Sonuç: Geç dönemde ortaya çıkan HGP etkenlerinin saptanmasında konvansiyonel yöntemler ile PCR arasında uyumun iyi olduğu ve PCR ile daha fazla hastada etken saptanabileceği bu çalışmada gösterilmiştir. Bakteriyel etkenlerin hızlı moleküler yöntemlerle saptanmaya başlanmasının, hastanede gelişen pnömoni etkenlerinin hızla belirlenmesi sonucu, etkin bir şekilde tedavi edilmesinin yolunu açabileceği düşünülmüştür.
Introduction and Purpose: Patients with late-onset hospital-acquired pneumonia pneumonia (HAP) that develop after the fifth day following admission to the hospital are usually caused by multi-drug resistant bacteria. Late detection of the pathogens and inability to start appropriate antibiotic on time have negative effect on HAP prognosis. The isolation of infectious microorganisms in a short term by fast molecular methods in the last years ensure that treatment can be started earlier and more effectively and this situation is thought to affect prognosis positively. In this study, it was aimed to determine the factors in HAP with rapid molecular methods and to compare the results with conventional methods. Material-Method: Total 62 patients, with HAP diagnosis according to the criteria of ATS/IDSA published in 2005, who were followed-up in the intensive care units of Anesthesia and Reanimation Department and Chest Disease Departments of Ege University Faculty of Medicine between January 2014 and January 2016, were taken into the study. Lower respiratory tract samples were obtained from patients after HAP diagnosis with bronchoscopic (BAL, BASP) and non-bronchoscopic (mini-BAL) methods. The samples were examined in terms of bacteriological agents with conventional methods and fast molecular methods. Results: 62 patients (42 males, mean age: 69.7 ± 15.6), diagnosed with hospital-acquired pneumonia, were included. 95.2% of the patients had comorbid disease. Invasive mechanical ventilation (IMV) was applied to 33 patients and IMV - non-invasive mechanical ventilation (NIV) was applied to 28 patients. At the time of hospital-acquired diagnosis; 39 of 59 patients had unilateral infiltration and 20 had bilateral infiltration on chest x-ray. Chest x-ray of three patients showed pleural effusion and increased density consistent with unilateral infiltration. Bacterial agent was detected in 40 (64.5%) of 62 patients with conventional method, whereas bacterial agent was isolated in 57 of 62 patients (91.9%) with polymerase chain reaction (PCR). It has been observed that the conventional method and the PCR method are compatible with each other in terms of detecting the agent (kappa:0.797). Besides, PCR was found to have a significantly higher rate of agent detection (p=0.0004). Acinetobacter baumannii was detected most frequently with both methods. In the follow-up, mortality was observed in 45 (72.6%) of 62 patients. Conclusion: It has been shown in this study that there is a good agreement between conventional methods and PCR in the detection of late-onset HAP agents and that agents can be detected by PCR in more patients. Detection of bacterial agents by rapid molecular methods is thought to lead to the effective treatment of hospital-acquired pneumonia by rapid identification of the causative agents.
Introduction and Purpose: Patients with late-onset hospital-acquired pneumonia pneumonia (HAP) that develop after the fifth day following admission to the hospital are usually caused by multi-drug resistant bacteria. Late detection of the pathogens and inability to start appropriate antibiotic on time have negative effect on HAP prognosis. The isolation of infectious microorganisms in a short term by fast molecular methods in the last years ensure that treatment can be started earlier and more effectively and this situation is thought to affect prognosis positively. In this study, it was aimed to determine the factors in HAP with rapid molecular methods and to compare the results with conventional methods. Material-Method: Total 62 patients, with HAP diagnosis according to the criteria of ATS/IDSA published in 2005, who were followed-up in the intensive care units of Anesthesia and Reanimation Department and Chest Disease Departments of Ege University Faculty of Medicine between January 2014 and January 2016, were taken into the study. Lower respiratory tract samples were obtained from patients after HAP diagnosis with bronchoscopic (BAL, BASP) and non-bronchoscopic (mini-BAL) methods. The samples were examined in terms of bacteriological agents with conventional methods and fast molecular methods. Results: 62 patients (42 males, mean age: 69.7 ± 15.6), diagnosed with hospital-acquired pneumonia, were included. 95.2% of the patients had comorbid disease. Invasive mechanical ventilation (IMV) was applied to 33 patients and IMV - non-invasive mechanical ventilation (NIV) was applied to 28 patients. At the time of hospital-acquired diagnosis; 39 of 59 patients had unilateral infiltration and 20 had bilateral infiltration on chest x-ray. Chest x-ray of three patients showed pleural effusion and increased density consistent with unilateral infiltration. Bacterial agent was detected in 40 (64.5%) of 62 patients with conventional method, whereas bacterial agent was isolated in 57 of 62 patients (91.9%) with polymerase chain reaction (PCR). It has been observed that the conventional method and the PCR method are compatible with each other in terms of detecting the agent (kappa:0.797). Besides, PCR was found to have a significantly higher rate of agent detection (p=0.0004). Acinetobacter baumannii was detected most frequently with both methods. In the follow-up, mortality was observed in 45 (72.6%) of 62 patients. Conclusion: It has been shown in this study that there is a good agreement between conventional methods and PCR in the detection of late-onset HAP agents and that agents can be detected by PCR in more patients. Detection of bacterial agents by rapid molecular methods is thought to lead to the effective treatment of hospital-acquired pneumonia by rapid identification of the causative agents.
Açıklama
Anahtar Kelimeler
Hastanede Gelişen Pnömoni, Bakteriyel Etkenler, Hızlı Moleküler Yöntemler, Hospital-Acquired Pneumonia, Bacterial Agents, Rapid Molecular Methods
