ALT SOLUNUM YOLU İNFEKSİYONLARININ TANISINDA BALGAM ÖRNEKLERİNİN YIKANMASININ KÜLTÜR SONUCUNA ETKİSİ

Abstract

Amaç: Alt solunum yolu infeksiyonlarında (ASYİ) Gram boyamanın ve balgam örneklerinin salin ile yıkanmasının katkısının değerlendirilmesi. Metod: Her bir küçük mikroskop alanı (10x) için 10 dan az yassı epitel hücresi içeren tüm örnekler kalitatif ve kantitatif olarak ekildi. Bulgular: ASYİ tanısıyla gönderilen 489 hastadan alınan 620 örnek değerlendirildi. Gram boyamanın duyarlılığı %78.6 , özgüllüğü %82 olarak değerlendirilirken, bu değerler H. influenzae ve S. pneumoniae için %100’ e ulaştı. Kantitatif yöntem kültür pozitifliğini %52’ den % 63.5’ a yükseltti. En sık izole edilen patojenler sırasıyla Haemophilus influenzae, Pseudomonas aeruginosa ve Streptococcus pneumoniae oldu. Sonuç: Ekspoktere balgam örneklerinin toplanması invaziv olmayan bir işlem olup salin ile yıkama sonrası yapılan Gram boyama ve kültür laboratuvar tanısını kolaylaştırabilir. Kültür öncesi Gram boyamada deneyimli bir personel H. influenzae and S. pneumoniae için ön değerlendirmeyi kolaylıkla yapabilir ve kültür sonuçları için gereken 48 saat öncesinde tanıya yardımcı olabilir.

Keywords

• Balgam, Kantitatif kültür, Alt solunum yolu infeksiyonu

References

1. 1. Winchester CC, Macfarlane T, Thomas M, Price D. Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care. Chest 2009, 135: 1163-1172.
2. 2. Baselski V, Wundericink R. Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev 1994; 7: 533- 558.
3. 3. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell D. Infectious Diseases Society of America/American Thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: 27- 72.
4. 4. Bartlett JG, Finegold SM. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. Am Rev Respir Dis 1978; 7:1019-1027.
5. 5. Kamruddin A, Wilson S, Jamal WY, et al. Causative bacteria of respiratory tract infections in Kwait by quantitative culture of sputum. J Infect Chemother 1999;5:217-219.
6. 6. Cao LD, Ishiwada N, Takeda N, et al. Value of washed sputum Gram stain smear and culture for management of lower respiratory tract infections in children. J Infect Chemother 2004; 10:31-36.
7. 7. Woodhead M, Blasi S, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26:1138-1180.
8. 8. Geckler RW, Gremillion DH, MacAllister CK, Ellenbogen C. Microscopic and bacterial comparison of paired sputa and transtracheal aspirates. J Clin Microbiol 1977; 6: 366- 369.

9. 9. Roche N, Kouassi B, Rabbat A, Mounedji A, Lorut C, Huchon G. Yield of sputum microbiological examination in patients hospitalized for exacerbations of chronic obstructive pulmonary disease with purulent sputum. Respiration 2007; 74: 19-25.
10. 10. Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 1999;116:40¡V46.
11. 11. Allegra L, Blasi F, Diano P, et al. Sputum color as a marker of acute bacterial exacerbations of chronic obstructive pulmonary disease. Resp Med 2005; 99: 742- 747.
12. 12. Cooper GM, Jones JJ, Arbique JC, Flowerdew GJ, Forward KR. Intra and inter technologist variability in the quality assessment of respiratory tract specimens. Diagn Microbiol Infect Dis 2000; 37: 231¡V235.
13. 13. Carrol K. Laboratory diagnosis of lower respiratory tract infections: controversy and conundrums. J Clin Microbiol 2002; 40: 3115- 3120
14. 14. Nagendra S, Bourbeau P, Brecher S, Dunne M, LaRocco M, Doern G. Sampling variability in the microbiological evaluation of expectorated sputa and endotracheal aspirates. J Clin Microbiol 2001; 39:2344¡V2347.
15. 15. Ewig S, Schlochtermeter M, Göke N, Niederman MS. Applying sputum as a diagnostic tool in pneumonia. Limited yield, minimal impact on treatment decisions. Chest 2002; 121:1486-1492.
16. 16. Parry CM, White RR, Ridgeway ER, Corkill JE, Smith GW. The reproducibility of sputum Gram film interpretation. J Infect 2000; 41:55-60.
17. 17. Roson B, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the usefulness of sputum Gram stain in the initial approach to communityacquired pneumonia requiring hospitalization. Clin Infect Dis 2000;31:869¡V874
18. 18. Reed WW, Byrd GS, Gates RH Jr, Howard RS, Weaver MJ: Sputum Gram¡¦s stain in community-acquired pneumococcal pneumonia- A meta-analysis. West J Med 1996; 165:197-204.
19. 19. Van der Eerden MM, Vlaspolder F, Graaff De CS, Groot T, Jansen HM, Boersma VG. Value of intensive diagnostic microbiological investigation in low- and high- risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2005; 24: 241-249.
20. 20. Kuijper EJ, Van Der Meer J, de Jong MD, Speelman P, Dankert J. Usefulness of Gram stain for diagnosis of lower respiratory tract infection or urinary tract infection and as an aid in guiding treatment. Eur J Clin Microbiol Infect Dis 2003; 22:228-234.
21. 21. Skerrett SJ. Diagnostic testing for community-acquired pneumonia. Clin Chest Med 1999;20:531¡V548.