Onkoloji hastanesindeki hastaların yara kültürlerinin değerlendirilmesi

Year 2024, Volume: 17 Issue: 4, 6 - 6

Ferzan Arslan Esra Tavukcu Buket Demirhan İpek Mumcuoğlu Turgay Ulaş Serap Suzuk Ayşe Semra Güreser Nese Inan Gülşen İskender Tuba Dal

https://doi.org/10.31362/patd.1424237

Abstract

Amaç: Bu çalışmanın amacı, yara kültürlerinden izole edilen bakterilerin etken/kolonizasyon ayrımının yapılmasında; hastaya ait demografik, klinik ve laboratuvar verilerinin değerlendirilmesi ve etken bakterilerin antimikrobiyal duyarlılıklarının belirlenmesidir.
Gereç ve yöntem: Bu retrospektif araştırma, 1 Ocak 2021-31 Aralık 2022 tarihleri arasında Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi’nde gerçekleştirildi. Çalışmaya, 186 hastaya ait 236 yara kültürü dahil edildi. Hastalara ait demografik veriler, klinik veriler ve laboratuvar sonuçları değerlendirildi. İzole edilen bakteriler ve antimikrobiyal duyarlılıkları belirlendi. Yara örneklerinin mikrobiyolojik kalitesini değerlendirmek için Q skor sistemi kullanıldı.
Bulgular: Vakaların 159'u (%85) yatan hastalardı. Toplam 119 (%63,9) hastada etken olarak kabul edildi. Q puanı 136 örnek için (%85,5) Q3 olarak değerlendirildi. Yara bakteri kültürlerinde en sık izole edilen mikroorganizmalar sırasıyla koagülaz negatif stafilokoklar (KNS) (%19), E. coli (%14,8) ve S. aureus (%13,1) oldu. Metisilin direnci oranı KNS’lerde %55,5; S. aureus'ta ise %54,1 olarak belirlendi. Enfeksiyöz hastaların 81'inde (%59,9) Gram negatif bakteri izole edildi. Enfekte yarası olan hastaların 39'unda (%32,7) cerrahi alan enfeksiyonu, 25'inde (%21) protez enfeksiyonu, 3'ünde (%2,5) diyabetik ayak enfeksiyonu vardı. Ameliyatlı, protezli ve diyabetik ayaklı hastalarda enfeksiyon oranları istatistiksel olarak anlamlı derecede yüksekti (p=0,054).
Sonuç: Q skorlaması yara enfeksiyonunda etkenin saptanması ve kolonizasyonun dışlanmasında güçlü bir belirteçtir ve gereksiz antibiyotik kullanımının önlenmesine yardımcı olur. Onkolojik hastalar gibi özel hasta gruplarının ampirik tedavilerinin verilmesinde lokal antibiyotik duyarlılık verilerinin güncel olarak incelenmesi gereklidir.

Keywords

Yara kültürü, Q skoru, onkoloji hastaları, antimikrobiyal duyarlılık

Assessment of wound cultures in an oncology hospital

Abstract

Purpose: The aim of this study is to evaluate the patient's demographic, clinical and laboratory data to determine whether the bacteria isolated from wound cultures are causative agents or colonization, and to determine their antimicrobial susceptibilities. This study aims to assess the demographic, clinical, and laboratory data of patients to distinguish between pathogenic bacteria and colonization in wound cultures, while also determining their antimicrobial susceptibilities.
Materials and methods: This retrospective research was conducted in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between January 1, 2021 and December 31, 2022. Two hundred thirty six isolates from 186 patients wound cultures were included in the study. Demographic data, clinical data and laboratory results of the patients were evaluated. The isolated bacteria and their antimicrobial susceptibilities were determined. The Q score system was used to evaluate the microbiological quality of wound samples.
Results: One hundred fifty nine cases (85%) were inpatients. Totally 119 (63.9%) patients were diagnosed with infection. The Q score for 136 samples (85.5%) was assessed as Q3. The most common isolated microorganisms were coagulase negative-staphylococci (CoNS) (19%), Escherichia coli (14.8%), and Staphylococcus aureus (13.1%), respectively in wound bacterial cultures. The methicillin resistance rate was 55.5% in CoNS and 54.1% in Staphylococcus aureus. Gram-negative bacteria were isolated in 81 (59.9%) infected patients.
Among patients with infected wounds, 39 (32.7%) patients had surgical site infections, 25 (21%) prosthesis infections, and diabetic foot infections 3 (2.5%). Infection rates were statistically significantly higher in patients with surgery, prosthesis, and diabetic foot (p=0.054).
Conclusion: The Q score serves as a strong indicator for identifying the causative agent in wound infection and distinguishing it from colonization, thus aiding in the prevention of unnecessary antibiotic use. Regular review of local antibiotic susceptibility data is crucial in the clinical treatment of specific patient groups with oncological conditions.

Keywords

Wound culture, Q score, oncology patient, antimicrobial susceptibility

Ethical Statement

Permission was obtained from University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital Non-Interventional Clinical Research Ethics Committee for the study (Permission Date: 11.01.2024, File/Permission number: 2023-12/125).

Supporting Institution

YOK

References

• 1. Cerrahi Alan Enfeksiyonu Sürveyansı. Available at: https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Rehberler/CERRAHI_ALAN_ENFEKSIYONU_SURVEYANSI.pdf. Accessed December 14, 2023
• 2. Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for wound infections. Adv Wound Care (New Rochelle) 2021;10:317-327. https://doi.org/10.1089/wound.2019.1103
• 3. Reeves N, Torkington J. Prevention of surgical site infections. Surgery (Oxford) 2021;40:20-24. https://doi.org/10.1016/j.mpsur.2021.11.008
• 4. Matkoski C, Sharp SE, Kiska DL. Evaluation of the Q score and Q234 systems for cost-effective and clinically relevant interpretation of wound cultures. J Clin Microbiol 2006;44:1869-1872. https://doi.org/10.1128/JCM.44.5.1869-1872.2006
• 5. McCarter YS, Sharp SE. Best laboratory practices for respiratory cultures. Clinical Microbiology Newsletter 2013;35:35-43. https://doi.org/10.1016/j.clinmicnews.2013.02.001
• 6. Alverdy JC, Hyman N, Gilbert J. Re-examining causes of surgical site infections following elective surgery in the era of asepsis. Lancet Infect Dis 2020;20:38-43. https://doi.org/10.1016/S1473-3099(19)30756-X
• 7. Wysocki AB. Evaluating and managing open skin wounds: colonization versus infection. AACN Clin Issues 2002;13:382-397. https://doi.org/10.1097/00044067-200208000-00005
• 8. Sen CK. Human Wound and Its Burden: Updated 2020 Compendium of Estimates. Advances in Wound Care 2021;10:281-292. https://doi.org/10.1089/wound.2021.0026
• 9. Guan H, Dong W, Lu Y, et al. Distribution and antibiotic resistance patterns of pathogenic bacteria in patients with chronic cutaneous wounds in China. Front Med 2021;8:609584. https://doi.org/10.3389/fmed.2021.609584
• 10. Li, T., Zhang, H., Chan, P. K., Fung, W. C., Fu, H., & Chiu, K. Y. Risk factors associated with surgical site infections following joint replacement surgery: a narrative review. Arthroplasty (London, England) 2022;4:11(e1-8). https://doi.org/10.1186/s42836-022-00113-y
• 11. Percival SL, Emanuel C, Cutting KF, Williams DW. Microbiology of the skin and the role of biofilms in infection. Int Wound J 2012;9:14-32. https://doi.org/10.1111/j.1742-481X.2011.00836.x
• 12. Kanza Gül D. Procalcitonin and C-reactive protein measurements in the early diagnosis of surgical site infections after cesarean section. CBUi SBED 2021;8:232-240. https://doi.org/10.34087/cbusbed.794037
• 13. Al-Said HM, Alghamdi A, Ashgar SS, et al. Isolation and Detection of Drug-Resistant Bacterial Pathogens in Postoperative Wound Infections at a Tertiary Care Hospital in Saudi Arabia. Saudi J Med Med Sci. 2023;11(3):229-234. https://doi:10.4103/sjmms.sjmms_405_22
• 14. Gizzie N, Adukwu E. Evaluation of Liquid-Based Swab Transport Systems against the New Approved CLSI M40-A2 Standard. J Clin Microbiol 2016;54:1152-1156. https://doi.org/10.1128/JCM.03337-15