Febril Nötropenik Ataklarda Kan Kültüründe Üreyen Bakteriler Mutlaka Kombine Tedavi Gerektiriyor Mu?

Yıl 2021, , 5 - 12, 30.04.2021

Selçuk Aksöz , Halit Özsüt

https://doi.org/10.35514/mtd.2021.40

Öz

Giriş
İnfeksiyonlar nötropenik hastalardaki en önemli morbidite ve mortalite nedenidir. Kan kültürleri de nötropenik hastalarda infeksiyon etkenlerini belirlemek ve her hastanenin belirlenen bu etkenlere göre febril nötropenik hastaların ampirik tedavisinde seçilecek antibiyotikleri seçmesinde en önemli materyaldir.
Gereç ve Yöntem
Bu çalışmada 1 Haziran 2005 - 1 Ağustos 2007 tarihleri arasında bir üniversite hastanesi hematoloji biriminde yatan febril nötropenik hastaların kan kültürlerindeki üremeler ve üreyen etkenlerin duyarlılıkları incelendi.
Bulgular
Çalışma süresi boyunca 50 hastada 61 nötropeni atağı incelendi ve toplam 72 bakteri izole edildi. Bu bakterilerin %69’u Gram-negatif çomak, %31 i Gram-pozitif olarak tespit edildi. Kan kültüründe üreyen bakteriler arasında E.coli en sık (n=31,%43) görülen etkendi. Daha sonra azalan sıklıkta Enterobacter spp (n=8,%11),K.pneumoniae (n=6,%8),Enterococcus spp (n=6,%8),MSSA(n=6,%8),MRKNS (n=5,%7),MSKNS (n=3,%4),MRSA (n=2,%3),Serratia marcescens (n=1,%1.4),P.aeruginosa (n=1,%1.4), Acinetobacter spp (n=1,%1.4), Salmonella spp (n=1,%1.4), K.oxytoca (n=1,%1.4) tespit edilmiştir. Bu bakterilerin duyarlılık paternleri incelendiğinde sırasıyla imipenem(%98),meropenem(%98),netilmisin(%84), sefoperazon-sulbaktam(%80), piperasilin-tazobaktam(%76), amikasin(%75), sefepim(%71), siprofloksasin(%57), seftazidim(%53)’ e duyarlı oldukları görüldü.
Bakteriyemiye neden olan hastalıklar incelendiğinde 19 hastada bakteriyemi kaynağı tespit edildi. Buna göre hastalarımızda en sık üriner sistem infeksiyonu(n=13,%68) olmak üzere, kateter infeksiyonu(n=3,%15) pnomoni(n=2,%10), yumuşak doku infeksiyonu(n=1,%5) saptandı.Çalışmamızda febril nötropenik hastalar için en önemli prognostik faktörler olarak MASCC skoru ve nötropeni süresi olduğu görülmüştür.

Anahtar Kelimeler

febril nötropeni, monoterapi, kombine tedavi

Do Bacteria Growing in Blood Culture in Febrile Neutropenic Attacks Necessarily Require Combined Treatment?

Öz

Introduction
Infections are the most important cause of morbidity and mortality in neutropenic patients. Blood cultures are the most important material in determining the infectious agents in neutropenic patients and choosing the antibiotics to be selected in the empirical treatment of febrile neutropenic patients according to these factors.
Materials and Methods
In this study, the susceptibility of the growth and reproductive factors in the blood cultures of febrile neutropenic patients in the hematology unit of a university hospital between 1 June 2005 and 1 August 2007 were investigated.
Results
During the study period, 61 neutropenia attacks in 50 patients were examined and a total of 72 bacteria were isolated. Of these bacteria, 69% were Gram-negative rods and 31% were Gram-positive. E.coli was the most common (n = 31, 43%) among the bacteria growing in the blood culture. Then, with decreasing frequency, Enterobacter spp (n = 8, 11%), K.pneumoniae (n = 6, 8%), Enterococcus spp (n = 6, 8%), MSSA (n = 6, 8%), MRKNS ( n = 5, 7%), MSCNS (n = 3, 4%), MRSA (n = 2, 3%), Serratia marcescens (n = 1, 1.4%), P.aeruginosa (n = 1, 1.4%) Acinetobacter spp (n = 1, 1.4%), Salmonella spp (n = 1, 1.4%), K.oxytoca (n = 1, 1.4%). Imipenem (98%), meropenem (98%), netilmicin (84%), cefoperazone-sulbactam (80%), piperacillin-tazobactam (76%), amikacin (75%), cefepime (71%) ), ciprofloxacin (57%) and ceftazidime (53%).
When bacterial diseases were investigated, bacteremia was detected in 19 patients. Accordingly, the most common urinary tract infection in our patients (n = 13, 68%), catheter infection (n = 3, 15%) pnomoni (n = 2, 10%), soft tissue infection (n = 1, 5%) In our study, the most important prognostic factors for febrile neutropenic patients were MASCC score and duration of neutropenia.

Conclusion
When blood culture growths are considered (P.aeruginosa, Acinetobacter spp), because of the relatively rare occurrence of cases, high-risk conditions are considered considering adverse effects such as nephrotoxicity and ototoxicity due to aminoglycosides and increased treatment costs. It was concluded that the use of combined therapy other than MASCC score, length of the expected duration of neutropenia, had no superiority to monotherapy.

Anahtar Kelimeler

Febrile Neutropenia, monotherapy, combined therapy

Kaynakça

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