Yoğun Bakım Ünitesinde Kan Şekeri Düzeyi ile Kültür Pozitifliği Arasındaki İlişki: Prospektif Gözlemsel Bir Çalışma

Yıl 2023, , 205 - 212, 25.12.2023

Süleyman Yıldırım , Hüseyin Oğuz Yılmaz , Yusuf Durmaz , Cenk Kıraklı

https://doi.org/10.57221/izmirtip.1264041

Öz

Giriş: Sepsis, yoğun bakım ünitesindeki (YBÜ) ölümlerin en önemli nedenlerinden biridir. Tedavi başlangıcında antibiyotikler ampirik olarak seçilir, daha sonra kültür sonuçlarına ve tedavi cevabına göre tedavi değiştirilir. Kritik hastalarda kültür pozitifliği ile ilişkili faktörler önemli bir konudur. Bu nedenle, çalışmamızda kan kültürü pozitifliği ile ilişkili faktörler, özellikle de kan kültürü örneklemesi sırasındaki kan glukoz seviyesi ile kan kültürü arasındaki ilişkinin incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu prospektif gözlemsel çalışma 1 Ekim 2017 ile 1 Ocak 2018 tarihleri arasında Sağlık Bilimleri Üniversitesi, Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi Yoğun Bakım Ünitesinde gerçekleştirilmiştir. Kan kültürü hastaların iki ayrı bölgesinden steril koşullar altında alınmıştır. Yatak başı kan şekeri ölçüm cihazı ile eş zamanlı kan glukoz düzeyi ölçülmüştür ve iki ölçümün ortalaması alınmıştır. Kan kültürü pozitifliği etkileyen faktörlerin belirlenmesi için multivariate regresyon analizi kullanılmıştır.
Bulgular: Çalışmaya 174 hasta alındı ve 53 (%30) hastada kan kültürü pozitifliği saptanmıştır. Univariate analizde kan glukoz düzeyi, santral venöz kateter varlığı, antibiyotik tedavisi, vazoaktif ilaç kullanımı ve diabetes mellitus (DM) kültür pozitifliği ile ilişki bulunmuştur. Multivariate regresyon analizinde sadece DM, kültür pozitifliği ile ilişkili bulunmuştur (OR 5.63 [95% CI 1.99-15.91] p=0,001).
Sonuç: DM kan kültürü pozitifliği olasılığını arttırabilir. Bu durum kontrolsüz DM’den kaynaklanmış olabilir. Bu riskin kontrolsüz hastalardan kaynaklanıp kaynaklanmadığını değerlendirmek için iyi tasarlanmış daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Kan Kültürü, Kan Glukoz Düzeyi, Yoğun Bakım Ünitesi, Diabetes Mellitus

Association Between Blood Glucose Level and Blood Culture Positivity in Intensive Care Unit: Prospective Observational Study

Öz

Aim: Sepsis is one of the major causes of death in intensive care unit (ICU). At the beginning antibiotics is chosen empirically after that is changed according to culture results or response to initial treatment. The factors associated culture positivity are of interest in the critically ill patients. Therefore, we aim in our study to explore the factors associated with blood culture positivity especially blood glucose levels at the time blood culture sampling.
Material and Methods: We perform this prospective observational study between October 1, 2017, and January 1, 2018, at University of Health Sciences Turkey, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Intensive Care Unit. Two separate samples from opposite sides of each patient were obtained, and blood glucose was measured simultaneously with bed-side blood glucose measurement device by using the blood drawn for blood culture for each vial. The average of the two measurements was considered as the simultaneous blood glucose level of the patient. Multivariate regression analysis was used to determine the factors that associated with blood culture positivity.
Results: 174 patients were enrolled into the study, blood culture positivity was detected in 53 (30%) patients. In univariate analyzes, blood glucose levels, presence of central venous catheter, antibiotic treatment, vasoactive drug infusion and diabetes mellitus (DM) were found to be associated with culture positivity. In multivariate regression analyze only DM was found to be associated culture positivity (OR 5.63 [95% CI 1.99-15.91] p=0,001).
Conclusion: DM increase possibility of blood culture positivity. It may stem from uncontrolled DM. Further well-designed studies are needed to evaluate if this risk is derived from uncontrolled patients.

Anahtar Kelimeler

Blood culture, Blood Glucose, Intensive Care Unit, Diabetes Mellitus

Kaynakça

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