Ev Tipi Mekanik Ventilatör ile Takip Edilen Hastalarda Trakeal Aspirat Kültürlerinin Değerlendirilmesi

Year 2023, , 340 - 345, 20.12.2023

Esra Akyüz Özkan , Demet Gür Vural

https://doi.org/10.46332/aemj.1192753

Abstract

Amaç: Evde mekanik ventilator (EMV) ile takip edilen hastaların altta yatan hastalıkları, başvuru şikayetleri, trakeal aspirat (TA) kültürlerinden alınan örneklerden izole edilen mikroorganizmalar ve antibiyotiklere dirençlerinin araştırılması amaçlandı.

Araçlar ve Yöntem: 1 Ocak 2020 – 1 Ocak 2021 tarihleri arasında TA kültürleri, bakterilerin tanımlanması ve antibiyotik duyarlılıkları VITEK 2 (bioMeriux, Fransa) otomatik tanımlama sistemi ile değerlendirildi. Hasta dosyalarından hastaların yaşı, cinsiyeti, altta yatan hastalıkları, evde ventilatör kullanım süreleri, şikayetleri ve laboratuvar verileri incelendi.

Bulgular: Çalışmada incelenen 91 ventilatör ilişkili pnömoni (VİP) hastalarının 72'si (%79) erkek ve ortalama yaş 91.64 ± 64.07 ay idi. En sık başvuru nedeni ateş ve nefes darlığı olup, hastaların %43.76'sı serebral palsi/epilepsi ve %10.4'ü sendrom tanısı aldı.
Örneklerden; 12'si (%13.3) Gram pozitif, 79'u (%86.7) Gram negatif olarak tanımlandı. 44 (%48.4) örnekte Pseudomonas aeruginosa, 9 (%9.9) örnekte Serratia marcescens, 8 (%8.8) örnekte Klebsiella spp, 12 (%13.3) örnekte Staphylococcus aureus tespit edildi. Karbapenem direnci Pseudomonas aeruginosa için %18.75, Klebsiella spp için %16, Escherichia coli için %12.5 ve Acinetobacter baumannii için %12 idi.

Sonuç: Ateş ve solunum sıkıntısı gibi enfeksiyon bulguları ile başvuran EMV hastalardan TA kültürü alınmalı ve sonuca göre tedavi düzenlenmelidir. Evde EMV ile takip edilen hastaların TA kültürü antibiyotik direnç oranlarının literatürdeki yoğun bakımda yatan hastalardan gönderilen TA kültürlerine göre daha düşük olduğu gözlendi.

Keywords

antibiyotik direnci, trakeal aspirat, evde mekanik ventilasyon, pediatri

Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators

Abstract

Purpose: To investigate the underlying diseases, and complaints of patients upon admission, isolated microorganisms from tracheal aspirate (TA) samples and their resistance to antibiotics in patients followed up with a home mechanic ventilator (HMV).

Materials and Methods: Between January 1, 2020 and January 1, 2021, TA cultures, identification of bacteria and their antibiotic susceptibilities were evaluated by VITEK 2 (bioMeriux, France) automated identification system. The patients' age, gender, underlying diseases, duration of home ventilator use, complaints, and laboratory data were reviewed.

Results: Of the 91 prediagnosed ventilator-associated pneumonia (VAP) patients, 72 (79%) were male and mean age was 91.64 ± 64.07 months. The most common reason for referral was fever and dyspnea and 43.76% of the patients were diagnosed with cerebral palsy/epilepsy and 10.4% with syndromes.
Of the samples; 12 (13.3%) were defined as Gram-positive and 79 (86.7%) as Gram-negative. Pseudomonas aeruginosa was detected in 44 (48.4%) samples, Serratia marcescens in 9 (9.9%), Klebsiella spp. in 8 (8.8%) and Staphylococcus aureus was in 12 (13.3%) samples. Carbapenem resistance was 18.75% for Pseudomonas aeruginosa, 16% for Klebsiella spp, 12.5 for Escherichia coli and 12% for Acinetobacter baumannii.

Conclusion: TA culture should be taken from patients with HMV who were admitted with signs of infection such as fever and respiratory distress and treatment should be arranged according to the result. It was observed that the TA culture antibiotic resistance rates of the patients with HMV were lower than the TA cultures sent from the patients hospitalized in the intensive care unit in the literature.

Keywords

Antibiotic resistance, tracheal aspirate, home mechanical ventilation, pediatrics

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