YOĞUN BAKIM ÜNİTESİNDE SEDASYON İÇİN KULLANILAN AJANLARIN ANTİBAKTERİYEL AKTİVİTELERİNİN İN VİTRO YÖNTEMLE DEĞERLENDİRİLMESİ Evaluation of the Antibacterial Activities of the Agents Used for Sedation in Intensive Care Unit In Vitro Method

Year 2019, Volume: 9 Issue: 2, 67 - 72, 28.06.2019

Emre Mutlu

Abstract

ÖZET

Amaç: Yoğun bakımda sedasyon, anksiyetenin ve ajitasyonun tedavisinde kullanılmaktadır. Bu çalışmada,

yoğun bakımda sedasyon amaçlı, infüzyon şeklinde yaygın olarak kullanılan propofol, ketamin,

tiyopental, deksmedotomidin ve midazolam’ın pratikte kullanılan dozlarının antimikrobiyal

aktivitesinin in vitro olarak araştırılması hedeflenmiştir.

Gereç ve Yöntem: İntravenöz anestezik ajanların in vitro antimikrobiyal aktiviteleri mikro dilüsyon

tekniği ile araştırıldı. Testte kullanılan mikroorganizmalar aşağıdaki gibidir: Escherichia coli (ATCC

25922), Yersinia psödotüberküloz (ATCC 911), Pseudomonas aeruginosa (ATCC 10145), Listeria

monocytogenes (ATCC 43251), Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC

25923), Bacillus cereus 702 Roma, Mycobacterium smegmatis (ATCC 607), Candida albicans (ATCC

60193) ve Saccharomyces cerevisiae RSKK 251. Antibakteriyel deneyler, pH 7.3'te Mueller-Hinton

sıvısında gerçekleştirildi ve pH 7.0'da tamponlu Maya Nitrojen Tabanı'nda antifungal analizler yapıldı.

Bulgular: Sadece ketamin içeren preparat antimikrobiyal aktivite gösterirken diğer ajanlar antimikrobiyal

etki göstermedi.

Sonuç: Yapılan çalışma sonucunda ketamin in vitro ortamda yoğun bakım ünitesinde sık görülebilen

mikroorganizmalar üzerinde antimikrobiyal etkinlik göstermiştir. Bununla birlikte, klinik kullanımda

ketaminin antimikrobiyal etkinliğini, antibiyotik tedavisine potansiyel katkısını ve yoğun

bakım ünitesi enfeksiyonlarının ortadan kaldırılmasına veya sepsisli hastalara ne kadar fayda sağlayacağını

değerlendirmek için in vivo çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Anestezikler; Ketamin; Yoğun bakım

ABSTRACT

Objective: Sedation in the intensive care unit is used for the treatment of anxiety and agitation.

This study aims to investigate the in vitro antimicrobial activity of propofol, ketamine, thiopental,

dexmedetomidine and midazolam doses used in practice for sedation purposes in the intensive

care unit.

Material and Methods: In vitro antimicrobial activities of intravenous sedative agents were

investigated by using the microdilution technique. Microorganisms used in the test were as

follows: Escherichia coli (ATCC 25922), Yersinia pseudotuberculosis (ATCC 911), Pseudomonas

aeruginosa (ATCC 27853), Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC

25923), Bacillus cereus 709 ROMA, Mycobacterium smegmatis (ATCC 607), Candida albicans (ATCC

60193), Candida tropicalis (ATCC 13803) and Saccharomyces cerevisiae RSKK 251. Antibacterial

experiments were performed in Mueller-Hinton Broth with a pH of 7.3, and antifungal analyses

were carried out in buffered Yeast Nitrogen Base with a pH of 7.0.

Results: Only the preparation with ketamine showed antimicrobial activity, whereas no

antimicrobial activity was detected in the preparations with the other agents.

Conclusion: Ketamine has antimicrobial activity in vitro on microorganisms frequently seen

in the intensive care unit practice. However, there is a need for in vivo studies to evaluate the

antimicrobial efficacy of ketamine in clinical use, its potential contribution to antibiotic therapy,

and how well it can eliminate intensive care unit infections or benefit the patients with sepsis.

Keywords: Anesthetics; Ketamine; Critical Care

Keywords

YOĞUN BAKIM ÜNİTESİNDE SEDASYON İÇİN KULLANILAN AJANLARIN ANTİBAKTERİYEL AKTİVİTELERİNİN İN VİTRO YÖNTEMLE DEĞERLENDİRİLMESİ Evaluation of the Antibacterial Activities of the Agents Used for Sedation in Intensive Care Unit In Vitro Method

References

• 1. Grossman S, Labedzki D, Butcher R, Dellea L. Definition and management of anxiety, agitation, and confusion in ICUs. Nursingconnections 1996;9(2):49–55. 2. Wang J, Peng Z-Y, Zhou W-H, Hu B, Rao X, Li J-G. A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China. Chin Med J (Engl) 2017;130(10):1182. 3. Mansouri P, Javadpour S, Zand F, Ghodsbin F, Sabetian G, Masjedi M, et al. Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial. J Crit Care 2013;28(6):918–22. 4. J. A, F. G, A. B, M. L. The agents used for sedation in neurointensive care unit. Ann Fr Anesth Reanim 2004;23(5):528–34. 5. Muellejans B, Matthey T, Scholpp J, Schill M. Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: A randomised, open-label, pharmacoeconomic trial. Crit Care 2006;10(3). 6. Muellejans B, López A, Cross MH, Bonome C, Morrison L, Kirkham AJT. Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit: a randomized double-blind controlled tria. Crit Care 2004;8(1):R1–11 7. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation. N Engl J Med 2000;342:1471–7. 8. BERRY CB, GILLESPIE T, HOOD J, SCOTT NB. Growth of micro‐organisms in solutions of intravenous anaesthetic agents. Anaesthesia 1993;48(1):30–2. 9. Langevin PB, Gravenstein N, Doyle TJ, Roberts SA, Skinner S, Langevin SO, et al. Growth of Staphylococcus aureus in Diprivan and Intralipid: Implications on the pathogenesis of infections. Anesthesiology 1999;91(5):1394–400. 10. Sosis MB, Braverman B. Growth of Staphylococcus aureus in four intravenous anesthetics. Anesth Analg. 1993;77(4):766–8.