COVID-19 Pandemisi Öncesi ve Döneminde Yoğun Bakım Ünitesinde Takip Edilen Hastaların Kan Kültürü İzolatlarının Tür Dağılımı ve Antibiyotik Duyarlılıklarının Değerlendirilmesi: Retrospektif, Tek Merkez Analizi

Yıl 2023, Cilt: 5 Sayı: 2, 71 - 77, 01.07.2023

Kadir Arslan , Ayça Sultan Şahin

https://doi.org/10.38175/phnx.1222179

Öz

Amaç: Bu çalışmanın amacı, COVID-19 pandemisi öncesi ve döneminde tersiyer bir merkezin Yoğun bakım ünitesinde (YBÜ) yatan hastaların kan kültürlerinden izole edilen mikroorganizma türlerinin tanımlanması ve antibiyotik duyarlılıklarının araştırılmasıdır.
Gereç ve Yöntem: 15 Mart 2019 ile 15 Mart 2021 arasındaki COVID-19 pandemisi öncesi ve sonrası 2 yıllık süreçte YBÜ’de yatan hastalar iki gruba ayrılarak kan kültürleri retrospektif olarak değerlendirildi. İzole edilen mikroorganizmalar ve antibiyotik duyarlılıkları analiz edildi.
Bulgular: Toplamda 1282 hastanın kan kültürü analiz edildi, demografik veriler gruplar arasında benzerdi. Pre-pandemik dönemdeki hastaların %39.6’sında (n=202) ve pandemik dönemdekilerin %41’inde (n=317) üreme saptandı. Tüm popülasyonun %71.3’ünde gram pozitif bakteriler, %21.6’sında gram negatif bakteriler ve %7.1’inde Candida spp. izole edildi. Pandemi dönemindeki kan kültürlerinde Klebsiella spp. anlamlı olarak yüksek, Enterococcus spp. ise anlamlı olarak düşüktü. COVID-19 döneminde Staphylococcus aureus, Klebsiella spp., E.coli, Enterobacter spp. ve Pseudomonas spp. için antibiyotik duyarlılıklarında anlamlı olmasa da azalma tespit edildi. Koagülaz negatif stafilokoklarda (KNS) ise teikoplanin ve linezolid duyarlılığında istatistiksel olarak anlamlı azalma mevcuttu. Pandemi dönemindeki hastaların %57.6’sı (n=172) COVID-19 pozitifti. COVID-19 pozitif hastalarda ise Candida spp. oranları anlamlı olarak yüksek iken antifungal duyarlılıkta azalma saptanmadı.
Sonuç: COVID-19 enfeksiyonunun bağışıklık sistemi zayıflamış hastalarda ağır seyretmesi, sekonder enfeksiyonlarda anlamlı artışa yol açarak pandemi dönemindeki hastalardan izole edilen Klebsiella suşlarında artışta ve antimikrobiyal duyarlılıktaki azalmalarda etkili olmuş olabilir. YBÜ’mizde izole odalarda takip edilen bu hastalardaki çapraz bulaşın azalmasının Enterococcus suşlarının anlamlı olarak düşük saptanmasında, tedavide yüksek doz steroidlerin kullanılmasının ise izole edilen Candida suşlarının artmasında etkili olduğunu düşünüyoruz.

Anahtar Kelimeler

Antibiyotik duyarlılığı, COVID-19, kan kültürü, yoğun bakım ünitesi

Destekleyen Kurum

Yoktur.

Proje Numarası

Yoktur.

Teşekkür

Yoktur.

Evaluation of Species Distribution and Antibiotic Susceptibility of Blood Culture Isolates of Patients Followed in the Intensive Care Unit Before and During the COVID-19 Pandemic: Retrospective, Single-Center Analysis

Öz

Objective: This study aims to identify the microorganism species isolated from blood cultures of patients hospitalized in the ICU of a tertiary center before and during the COVID-19 pandemic and to investigate their antibiotic susceptibility.
Material and Method: Patients hospitalized in the ICU two years before and after the COVID-19 pandemic between March 15, 2019, and March 15, 2021, were divided into two groups, and their blood cultures were evaluated retrospectively. Isolated microorganisms and their antibiotic susceptibility were analyzed.
Results: A total of 1282 patients’ blood cultures were analyzed, and demographic data were similar between groups. Blood culture growth was detected in 39.6% (n=202) of the patients in the pre-pandemic period and 41% (n=317) in the pandemic period. Gram-positive bacteria were isolated in 71.3%, gram-negative bacteria in 21.6%, and Candida spp. in 7.1% of the population. Klebsiella spp. was significantly higher, and Enterococcus spp. was significantly lower in blood cultures during the pandemic. In the COVID-19 period, although not significant, a decrease in antibiotic susceptibility was detected for Staphylococcus aureus, Klebsiella spp., E.coli, Enterobacter spp., and Pseudomonas spp. There was a statistically significant decrease in susceptibility to teicoplanin and linezolid in coagulase-negative staphylococci (CNS). During the pandemic, 57.6% (n=172) of the patients were positive for COVID-19. In COVID-19-positive patients, while Candida spp. was significantly higher, no decrease in antifungal susceptibility was detected.
Conclusion: The severe COVID-19 infection in immunocompromised patients may have led to a significant increase in secondary infections, contributing to the increase in Klebsiella strains isolated from patients in the pandemic period and the reduction in antimicrobial susceptibility. The decrease in cross-contamination in these patients, who were followed up in isolated rooms in our ICU, was influential in the significantly lower detection of Enterococcus strains. High-dose steroids in the treatment effectively increased the number of isolated Candida strains.

Anahtar Kelimeler

Antibiotic sensitivity, COVID-19, blood culture, intensive care unit

Proje Numarası

Yoktur.

Kaynakça

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