Genel Yoğun Bakımda Takip Edilen Hastalarda Kültür Sonuçlarının Araştırılması

Year 2025, Volume: 22 Issue: 4, 782 - 791, 25.12.2025

Osman Alaca Mehmet Kenan Erol , Nuray Altay

https://doi.org/10.35440/hutfd.1774753

Abstract

Amaç: Yoğun bakım ünitelerinde (YBÜ) gelişen hastane kaynaklı enfeksiyonlar, morbidite, mortalite ve sağlık bakım maliyetlerini artıran önemli sorunlardandır. Mikroorganizmaların doğru belirlenmesi, hem erken tanı hem de uygun antibiyotik tedavisi açısından kritik rol oynamaktadır. Bu çalışmanın amacı, genel yoğun bakımda takip edilen hastalarda kültür sonuçlarını incelemektir.
Materyal ve metod: Çalışma, 01.01.2021-01.01.2024 tarihleri arasında genel YBÜ’de en az üç gün yatışı bulunan 276 hasta üzerinde retrospektif olarak yürütüldü. Hastaların demografik özellikleri, yatış tanıları, laboratuvar bulguları ve taburculuk sonuçları incelendi. Kan, idrar, derin trakeal aspirat ve kateter kültürlerinde üreyen mikroorganizmalar kaydedildi. Veriler SPSS 25.0 programı ile analiz edildi.
Bulgular: Katılımcıların %54’ü erkek (n=149), %46’sı kadın (n=127) olup yaş ortalaması 60,93±19,13 idi. En sık yatış nedeni solunum yetmezliği (%29,7) olarak bulundu. Hastaların %83,3’ü (n=230) kaybedildi. Kültür sonuçlarında en sık izole edilen etkenler kan kültürlerinde Klebsiella pneumoniae (%11,2), Staphylococcus epidermidis (%6,2) ve Pseudomonas aeruginosa (%6,2); trakeal aspiratlarda Klebsiella pneumoniae (%13,4) ve Acinetobacter baumannii (%13,0); idrar kültürlerinde Escherichia coli (%4,3); kateter kültürlerinde Klebsiella pneumoniae (%3,3) idi. Negatiflik oranı özellikle üçüncü kan kültüründe %96,6’ya ulaştı.
Sonuç: Yoğun bakım hastalarında mortalite oranı oldukça yüksek bulunmuştur. Gram-negatif bakteriler başlıca etkenlerdir ve ampirik antibiyotik tedavisinde özellikle Klebsiella pneumoniae, Acinetobacter baumannii ve Pseudomonas aeruginosa’ya dikkat edilmelidir. Ayrıca, kültürlerdeki yüksek negatiflik oranı örnekleme zamanı ve laboratuvar süreçlerinin optimizasyonunun önemini göstermektedir.

Keywords

Yoğun bakım , Kültür , Klebsiella pneumoniae , Hastane enfeksiyonları

Ethical Statement

Çalışmanın yürütülmesi için ilgili kurumdan gerekli kurum izni ve bağlı bulunulan Harran Üniversitesi'nin Klinik Araştırmalar Etik Kurulu’ndan 11.12.2023 tarih ve 2023/23-27 sayılı karar ile etik onayı alınmıştır

Investigation of Culture Results in Patients Followed in General Intensive Care

Abstract

Background: Hospital-acquired infections in intensive care units (ICUs) represent a major cause of morbidity, mortality, and increased healthcare costs. Accurate identification of microorganisms plays a critical role in early diagnosis and guiding appropriate antibiotic therapy. The aim of this study is to examine culture results in patients monitored in the general intensive care unit.
Materials and Methods: A retrospective study was conducted on 276 patients aged ≥18 years who were hospitalized in a general ICU for at least three days between January 1, 2021, and January 1, 2024. Demographic data, admission diagnoses, laboratory findings, and discharge outcomes were recorded. Microorganisms isolated from blood, urine, deep tracheal aspirate, and catheter cultures were analyzed. Statistical analyses were performed using SPSS version 25.0.
Results: Of the patients, 149 (54%) were male and 127 (46%) female, with a mean age of 60.93±19.13 years. Respiratory failure (29.7%) was the most frequent admission diagnosis. Mortality was observed in 230 patients (83.3%). The most common isolates were Klebsiella pneumoniae (11.2%), Staphylococcus epidermidis (6.2%), and Pseudomonas aeruginosa (6.2%) in blood cultures; Klebsiella pneumoniae (13.4%) and Acinetobacter baumannii (13.0%) in tracheal aspirates; Escherichia coli (4.3%) in urine cultures; and Klebsiella pneumoniae (3.3%) in catheter cultures. Negative results were frequent, reaching 96.6% in the third blood culture.
Conclusions: Mortality rates were high among ICU patients. Gram-negative bacteria predominated, highlighting the importance of considering Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa in empirical therapy. The high rate of negative cultures underscores the need for optimized sampling techniques and laboratory procedures.

Keywords

Intensive care unit , Culture , Klebsiella pneumoniae , Hospital-acquired infections

Ethical Statement

The necessary institutional permission was obtained from the relevant institution for the conduct of the study, and ethical approval was obtained from the Clinical Research Ethics Committee of the affiliated university with decision number 2023/23-27 dated 12/11/2023.

References

• 1. De Waele JJ. Importance of timely and adequate source control in sepsis and septic shock. Journal of Intensive Medicine [Internet]. 2024;4(3):281- 6. Available from: https://doi.org/10.1016/j.jointm.2024.01.002
• 2. Ji W, Meng Y, Bo L, Wan X, Deng X. Interpretation of surviving sepsis campaign: international guidelines for the management of sepsis and septic shock 2021. Vol. 41, Chinese Journal of Anesthesiology. 2021. 1409- 1413 p.
• 3. Isaranuwatchai S, Buppanharun J, Thongbun T, Thavornwattana K, Harnphadungkit M, Siripongboonsitti T. Early antibiotics administration reduces mortality in sepsis patients in tertiary care hospital. BMC Infectious Diseases [Internet]. 2025;25(1). Available from: https://doi.org/10.1186/ s12879-025-10532-2
• 4. Haitsma Mulier JLG, van Dijk FJ, Schweitzer VA, Bonten MJM, Derde LPG, Cremer OL. Optimizing microbiological surveillance during selective digestive decontamination in the intensive care unit: an in silico simulation study. Critical Care. 2025;29(1).
• 5. Gupta E, Saxena J, Kumar S, Sharma U, Rastogi S, Srivastava VK, et al. Fast Track Diagnostic Tools for Clinical Management of Sepsis: Paradigm Shift from Conventional to Advanced Methods. Diagnostics. 2023;13(2):1-23.
• 6. Adal O, Tsehay YT, Ayenew B, Abate TW, Mekonnen GB, Mulatu S, et al. The burden and predictors of hospital-acquired infection in intensive care units across Sub-Sahara Africa: systematic review and metanalysis. BMC Infectious Diseases. 2025;25(1).
• 7. Owens PL, Liang L, Barrett ML, Fingar KR. Comorbidities Associated With Adult Inpatient Stays, 2019. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. 2006;1-17. Available from: http://www.ncbi. nlm.nih.gov/pubmed/28498196
• 8. Hao M, Chen H, Wang J, Tang Y, Wu Y, Jin Y, et al. Investigation and epidemiological analysis of chronic diseases and comorbidities in hospitalized patients. Journal of Shanghai Jiaotong University (Medical Science). 2024;44(4):462-8.
• 9. Llitjos JF, Carrol ED, Osuchowski MF, Bonneville M, Scicluna BP, Payen D, et al. Enhancing sepsis biomarker development: key considerations from public and private perspectives. Critical Care [Internet]. 2024;28(1):1-15. Available from: https://doi.org/10.1186/s13054-024-05032-9
• 10. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine [Internet]. 2021;47(11):1181-247. Available from: https://doi.org/10.1007/s00134- 021-06506-y
• 11. Jiang X, Zhang C, Pan Y, Cheng X, Zhang W. Effects of C-reactive protein trajectories of critically ill patients with sepsis on in-hospital mortality rate. Scientific Reports [Internet]. 2023;13(1):1-9. Available from: https://doi. org/10.1038/s41598-023-42352-2
• 12. Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, et al. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Medicine. 2023;49(2):178-90.
• 13. Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. Journal of the Intensive Care Society. 2023;24(4):372-8.
• 14. He Y, Xu J, Shang X, Fang X, Gao C, Sun D, et al. Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study. Frontiers in Cellular and Infection Microbiology. 2022;12(July):1-15.
• 15. Rand KH, Beal SG, Rivera K, Allen B, Payton T, Lipori GP. Hourly effect of pretreatment with IV antibiotics on blood culture positivity rate in emergency department patients. Open Forum Infectious Diseases. 2019;6(5).
• 16. Yücel N, Kuzucu Ç, Yetkin F, Tunç E. Enfeksiyon bulguları ile acil servise başvuran hastaların kültür sonuçlarının değerlendirilmesi. İnönü Üniversitesi Tıp Fakültesi Dergisi. 2010;17(4):359-64.
• 17. Chiotos K, Lee G, Sydney G, Woods-Hill C, Wolfe H, Stinson HR, et al. Impact of a tracheal aspirate culture diagnostic test stewardship intervention in a tertiary care PICU. Infection Control and Hospital Epidemiology. 2024;45(8):943-51.